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A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES TOWARD SUICIDE MANAMI KODAKA, VITA POŠTUVAN, MASATOSHI INAGAKI & MITSUHIKO YAMADA ABSTRACT Background: Studies on attitudes toward suicide are of great interest to researchers worldwide. Although various instruments have been developed to measure attitudes toward suicide, psychometric properties of these instruments have not been systematically reviewed and organized. Aim: We aimed to identify valid, reliable and feasible attitudinal scales by system- atically reviewing published articles on scale development and validation studies. In particular, this study focused on scales used for a wide range of populations to measure multidimensional attitudes toward suicide and related issues. Methods: Electronic searches of two databases, PubMed and PsychInfo, were per- formed. Scales with unique names were identified and listed after reviewing selected publications, and then evaluated for psychometric properties, multidimensionality and appropriateness for a wide range of populations. Results: A total of 2,210 publications were identified by the first electronic search. In the final review process of the selected publications, three scales – the Suicide Opinion Questionnaire (SOQ), Suicide Attitude Questionnaire (SUIATT) and Attitudes Toward Suicide (ATTS) – were identified. Conclusion: Each of these scales has its own characteristics and should be used in accordance with research purposes. Key words: suicide, attitude, scales, psychometric properties, systematic review BACKGROUND Studies on attitudes toward suicide are of great interest to researchers worldwide. ‘Attitude’ is an evaluation of the entity, expressed in one’s affects, behaviour or cognition (Myers, 1993). Under- standing attitudes toward suicide may be useful in suicide prevention and in providing intervention for suicidal individuals. People with histories of suicide attempts or suicidal thoughts are reported to be more accepting of suicide compared to those without such a history (Limbacher & Domino, 1985–86). The more permissive attitudes toward suicide have been significantly associated with greater suicide ideation in adolescence (Stein et al., 1998). In a study of university students, those with histories of suicide International Journal of Social Psychiatry. © The Author(s), 2010. Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav Vol 57(4): 338–361 DOI: 10.1177/0020764009357399
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A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES TOWARD SUICIDE
MANAMI KODAKA, VITA PO!TUVAN, MASATOSHI INAGAKI & MITSUHIKO YAMADA
ABSTRACTBackground: Studies on attitudes toward suicide are of great interest to researchers worldwide. Although various instruments have been developed to measure attitudes toward suicide, psychometric properties of these instruments have not been systematically reviewed and organized.Aim: We aimed to identify valid, reliable and feasible attitudinal scales by system-atically reviewing published articles on scale development and validation studies. In particular, this study focused on scales used for a wide range of populations to measure multidimensional attitudes toward suicide and related issues.Methods: Electronic searches of two databases, PubMed and PsychInfo, were per-formed. Scales with unique names were identified and listed after reviewing selected publications, and then evaluated for psychometric properties, multidimensionality and appropriateness for a wide range of populations.Results: A total of 2,210 publications were identified by the first electronic search. In the final review process of the selected publications, three scales – the Suicide Opinion Questionnaire (SOQ), Suicide Attitude Questionnaire (SUIATT) and Attitudes Toward Suicide (ATTS) – were identified.Conclusion: Each of these scales has its own characteristics and should be used in accordance with research purposes.
Key words: suicide, attitude, scales, psychometric properties, systematic review
BACKGROUND
Studies on attitudes toward suicide are of great interest to researchers worldwide. ‘Attitude’ is an evaluation of the entity, expressed in one’s affects, behaviour or cognition (Myers, 1993). Under-standing attitudes toward suicide may be useful in suicide prevention and in providing intervention for suicidal individuals.
People with histories of suicide attempts or suicidal thoughts are reported to be more accepting of suicide compared to those without such a history (Limbacher & Domino, 1985–86). The more permissive attitudes toward suicide have been significantly associated with greater suicide ideation in adolescence (Stein et al., 1998). In a study of university students, those with histories of suicide
International Journal of Social Psychiatry. © The Author(s), 2010. Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav Vol 57(4): 338–361 DOI: 10.1177/0020764009357399
ideation were more likely to agree with the notion that suicidal behaviour is normal and that people have the right to die by suicide (McAuliffe et al., 2003). Thus, education aimed at changing attitudes toward suicide may aid in suicide prevention.
Attitudes of medical staff toward suicide affect their provision of care to suicidal patients (Bagley & Ramsay, 1989). Psychiatric nurses were more understanding and willing to provide care to suicidal patients compared to nurses working in physical disciplines (Samuelsson et al., 1997b). Accordingly, education aimed at changing attitudes toward suicide may help professionals improve the quality of their care and influence others in the community to be more helpful toward suicidal individuals.
Attitudes of politicians toward suicide and suicide prevention were qualitatively studied for the first time by Knizek et al. (2008). A comparative study of the attitudes of politicians from five European countries revealed differences in beliefs on suicide and suicide prevention. Knizek et al. (2008) suggested that politicians need to increase their awareness and knowledge of suicide and suicide prevention because they are responsible for initiating and funding suicide prevention programmes.
Scales that assess attitudes toward suicide require adequate validity, reliability and high feasibility. Although various instruments have been developed to measure attitudes toward suicide, the validity, reliability and feasibility of these instruments have not been systematically reviewed. In the present study, we aimed to identify valid, reliable and feasible attitudinal scales by systematically reviewing published articles on scale development and validation studies. In particular, this study focused on scales used for a wide range of populations to measure multidimensional attitudes toward suicide and related issues.
METHODS
Process of scale selectionElectronic searches of two databases, PubMed (National Centre for Biotechnology Information) and PsychInfo (American Psychological Association), were performed. We searched for citations from the earliest years that the databases cover (1949 for PubMed; the early 1800s for PsychInfo) up until March 31, 2009. Notably, the earliest publications found through PubMed and PsychInfo and reviewed in this study were published in 1969 and 1928. Search terms were (suicid* OR suicide) AND (attitud* OR attitude) AND (survey* OR survey OR questionnaire* OR questionnaire OR instru-ment* OR instrument OR measurement* OR measurement OR scale* OR scale). Abstracts were reviewed by two independent researchers and full-text publications that met inclusion criteria were retrieved. Inclusion criteria were: (1) articles and book chapters that refer to attitudes toward suicide or related issues, including suicidal behaviour, suicidal patients and suicide prevention, but excluding attitudes toward self-harm, parasuicide, euthanasia, assisted suicide, suicide bombing, and life and death; and (2) published material written in English.
When choosing publications for further review we included studies that used or referred to instru-ments with unique names. A manual search was also performed by reviewing references listed in the selected publications; articles and book chapters referring to the named instruments were also included. Scales with unique names used to measure attitudes toward suicide and related issues were identified and listed after reviewing all selected publications.
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 339
340 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
Process of scale evaluationDevelopment or validation studies of the identified scales were reviewed and organized. We clarified study objectives and then characterized scale items, response options and development processes. Finally, scales were evaluated for validity, reliability, feasibility, multidimensionality and appropriateness for a wide range of populations based on the factors listed below:
(a) Validity: adoption of the theoretical concepts of ‘attitude’ or ‘attitude towards suicide’; util- ization of extensive literature reviews, expert consensus and/or focus group interviews during the process of scale development; interpretable results of factor analysis; correlations with external criteria; and any other information.
(b) Reliability: internal consistency (e.g. Cronbach’s ); stability (e.g. results of test-retest or split-half reliability tests); reproducibility (e.g. replication of factor structure among different populations); and any other information.
(c) Feasibility: the number of items and complexity of rating method, and any other information.(d) Multidimensionality: inclusion of comprehensive attitudinal dimensions based on extensive
past studies or theoretical backgrounds of attitudes toward suicide, and composition of multiple factors.
(e) Appropriateness for a wide range of populations: not limited for use among particular age groups, people with a specific cultural background, or those working in certain professional disciplines.
RESULTS
Scale selectionFigure 1 displays the process of scale selection and its results. A total of 2,210 publications were iden-tified by the first electronic search. In the final review process of the selected publications, 18 scales that measure attitudes toward suicide and related issues were identified for detailed review.
Figure 1. Process of scale selection and its results
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 341
Table 1 displays the 18 scales and their characteristics. Three of these scales – the Suicide Opinion Questionnaire (SOQ), Suicide Attitude Questionnaire (SUIATT) and Attitudes Toward Suicide (ATTS) – were identified as multidimensional scales that can be used for a wide range of populations.
Reviews of the three identified scales
Suicide Opinion Questionnaire
Validity No descriptions exist on theoretical backgrounds for attitudes toward suicide adopted in the development of items for the SOQ. The initial item pool consisted of approximately 3,000 items derived from extensive literature reviews related to suicide (Domino et al., 1980, 1982). After redundant items and those with vague wording were excluded and opinions of professionals and graduate students were taken into account, 138 items remained (Domino et al., 1982). The final 100 items were those for which test-retest reliability coefficients were higher than 0.68.
Various study groups have developed interpretable subscales of the SOQ through factor analysis or content analysis; however, they have not achieved a consensus on its psychometric properties. In the early years of SOQ history, content analysis identified eight item categories (Domino et al., 1980), but subsequent factor analysis provided the 15-factor model (Domino et al., 1982). Domino (2005) recommended the eight-factor clinical scale model, which was developed through statistical analysis as well as clinical perspectives (Domino et al., 1988). Rogers and DeShon (1992) then developed a new five-factor model by performing item-total correlation and factor analysis. The most recent study was conducted by Anderson et al. (2008), in which exploratory factor analysis provided a two-factor structure. The SOQ has not been examined for correlation with any external criteria.
Reliability Various studies examined internal consistency by calculating Cronbach’s coefficients for different SOQ subscale models (Anderson et al., 2008; Rogers & DeShon, 1992, 1995) (details in Table 1). Most coefficients were lower than 0.70, which is considered the lowest acceptable value (Kaplan & Saccuzzo, 2005).
Test-retest reliability was examined for the eight-factor clinical scale model (Domino, 1996; Domino et al., 1988) and five-factor model (Rogers & DeShon, 1995). Most reliability coefficients ranged from moderate to high (Table 1).
Consensus has not been reached on the reproducibility of SOQ subscales. Rogers and DeShon (1992) reported that Domino’s eight-factor clinical scale model did not match their data from con-firmatory factor analysis. However, Rogers and DeShon (1995) further examined the reliability of the five-factor model they had developed (Rogers & DeShon, 1992) and determined that it was reproducible. More recently, Anderson et al. (2008) concluded that confirmatory factor analysis failed to support the 15-factor model, eight-clinical-scale model or five-factor model. A confirmatory factor analysis conducted in their subsequent study provided no support for the two-factor model that they had developed themselves (Anderson et al., 2008).
Feasibility The SOQ consists of too many items for use in clinical settings or large survey studies. It contains 100 five-point Likert items; 65 are considered attitudinal and the rest factual (Domino, 2005). In addition to the 100 Likert items, seven items ask respondents about their gender, history of suicidal thoughts or suicide attempts, whether they know anyone who died by suicide and the respondent’s relationship to that individual, probability of respondent’s future suicide attempt, and honesty of respondent’s answers to the questionnaire (Domino et al., 1982).
342 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
Tabl
e 1
Iden
tifie
d sc
ales
and
thei
r ch
arac
teri
stic
s
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Suic
ide
Opi
nion
Q
uest
ionn
aire
(S
OQ
) (SO
Q-C
)
• SO
Q(D
omin
o et
al.,
198
2)
Com
pare
s at
titud
es
tow
ard
suic
ide
amon
g co
mm
uniti
es, e
valu
ates
tr
aini
ng a
nd e
duca
tion
prog
ram
mes
for
prof
essi
onal
s, a
nd o
ther
re
late
d re
sear
ch.
• SO
Q-C
(Dom
ino
et a
l., 1
986)
M
easu
res
child
ren’
s at
titud
es to
war
d su
icid
e.
• SO
Q(D
omin
o et
al.,
198
2)
Con
sist
s of
100
+7 it
ems.
R
espo
nden
ts a
nsw
er th
e ite
ms
usin
g a
five-
poin
t sc
ale:
str
ongl
y ag
ree;
ag
ree;
dis
agre
e; s
tron
gly
disa
gree
; und
ecid
ed.
• SO
Q-C
(Dom
ino
et a
l., 1
986)
C
onsi
sts
of 5
6+5
item
s.R
espo
nden
ts a
nsw
er
the
item
s us
ing
thre
e ca
tego
ries
: agr
ee;
disa
gree
; und
ecid
ed.
• SO
Q(D
omin
o et
al.,
198
0,
1982
) Ini
tial 3
,000
ite
ms
wer
e de
rived
fr
om e
xten
ded
liter
atur
e re
view
. Red
unda
nt it
ems
and
thos
e w
ith v
ague
w
ordi
ng w
ere
excl
uded
.B
ased
on
opin
ions
of
pro
fess
iona
ls a
nd
grad
uate
stu
dent
s, 1
38
item
s w
ere
sele
cted
and
ad
min
iste
red
to c
olle
ge
stud
ents
twic
e w
ith a
si
x-w
eek
inte
rval
. Aft
er
excl
udin
g ite
ms
with
lo
w te
st-r
etes
t rel
iabi
lity
coef
ficie
nts,
100
item
s re
mai
ned.
•SO
Q-C
(Dom
ino
et a
l., 1
986)
D
ropp
ed it
ems
that
re
quir
ed c
ompl
ex
judg
emen
t or a
dult-
leve
l un
ders
tand
ing.
• SO
QSc
ale
deve
lopm
ent
stud
y: C
olle
ge s
tude
nts
in th
e U
S [9
6]
(Dom
ino
et a
l., 1
982)
V
alid
atio
n st
udie
s:
Col
lege
stu
dent
s [8
00]
(Dom
ino
et a
l., 1
980)
G
radu
ate
stud
ents
, m
edic
al p
rofe
ssio
nals
, an
d la
y pe
ople
[285
] (D
omin
o et
al.,
198
2)
Col
lege
stu
dent
s in
N
ew Z
eala
nd a
nd th
e U
S [4
84] (
Dom
ino
et a
l., 1
988)
Col
lege
st
uden
ts [2
37] (
Rog
ers
& D
eSho
n, 1
992)
C
olle
ge s
tude
nts
[452
] (R
oger
s &
DeS
hon,
19
95) S
tude
nts,
men
tal
heal
th p
rofe
ssio
nals
, m
edic
al p
erso
nnel
, te
ache
rs a
nd v
olun
teer
s in
eig
ht c
ount
ries
[642
] (D
omin
o, 1
996)
Col
lege
st
uden
ts, c
omm
unity
ad
ults
and
bus
ines
s pe
ople
in th
e U
S an
d la
y pe
ople
in T
aiw
an [5
09]
(Dom
ino
et a
l., 2
000)
Stud
y 1:
Com
mun
ity
peop
le a
nd g
radu
ate
stud
ents
[568
]; S
tudy
2:
colle
ge s
tude
nts
[288
] (A
nder
son
et a
l., 2
008)
C
olle
ge s
tude
nts
[288
] (L
este
r, 20
08)
• SO
Q
1. N
ot m
entio
ned.
2.
Bas
ed o
n ex
tend
ed
liter
atur
e re
view
an
d op
inio
ns o
f pr
ofes
sion
als
and
grad
uate
stu
dent
s (D
omin
o et
al.,
198
2).
3. N
o co
nsen
sus
on
fact
or s
truc
ture
has
be
en a
chie
ved.
Con
tent
an
alys
is b
ased
mod
el:
Eig
ht-a
rea-
mod
el
(Dom
ino
et a
l., 1
980)
. E
ight
-fac
tor c
linic
al
scal
e m
odel
(64
item
s)
(Dom
ino
et a
l., 1
988)
. Fa
ctor
ana
lysi
s ba
sed
mod
el:F
ifte
en-f
acto
r m
odel
(82
item
s;
cum
ulat
ive
prop
ortio
n:
76.7
%) (
Dom
ino
et
al.,
198
2). F
ive-
fact
or
mod
el (5
2 ite
ms;
cu
mul
ativ
e pr
opor
tion:
72
.0%
) (R
oger
s &
D
eSho
n, 1
992)
. Tw
o-fa
ctor
mod
el
(32
item
s; c
umul
ativ
e pr
opor
tion:
14.
86%
) (A
nder
son
et a
l., 2
008)
. 4.
Not
men
tione
d.
5. ‘U
ndec
ided
’ was
ve
ry c
omm
only
cho
sen
(Les
ter,
2008
).
• SO
Q1.
=
0.5
2, 0
.30,
0.8
3,
0.63
, 0.2
6, 0
.56,
0.4
9, 0
.40
(eig
ht-f
acto
r clin
ical
sca
le
mod
el).
= 0
.89,
0.7
5, 0
.73,
0.7
3,
0.60
(five
-fac
tor m
odel
) (R
oger
s &
DeS
hon,
199
2).
= 0
.85,
0.6
6, 0
.48,
0.
56, 0
.68,
0.5
9 (fi
ve-
fact
or m
odel
) (R
oger
s &
D
eSho
n, 1
995)
. =
0.4
1, 0
.76,
0.6
7, 0
.75,
0.
31, 0
.14,
0.1
3, 0
.08,
0.
42, 0
.29,
0.1
9, 0
.04,
0.
54, 0
.46,
0.2
1 (1
5-fa
ctor
mod
el).
= 0
.23–
0.75
eig
ht-f
acto
r cl
inic
al s
cale
mod
el),
= 0
.53–
0.82
(five
-fac
tor
mod
el) (
And
erso
n et
al.,
20
08).
= 0
.86,
0.8
6 (t
wo-
fact
or
mod
el) (
And
erso
n et
al.,
200
8).
2. E
stim
ates
of t
est-
rete
st
relia
bilit
y of
eig
ht-f
acto
r cl
inic
al s
cale
mod
el: 0
.83,
0.
86, 0
.79,
0.8
2, 0
.76,
0.
77, 0
.75,
0.7
5 (D
omin
o et
al.,
198
8).
Med
ian
estim
ates
of
test
-ret
est r
elia
bilit
y of
eig
ht-f
acto
r clin
ical
sc
ale
mod
el a
cros
s ei
ght
coun
trie
s: 0
.91,
0.8
7, 0
.89,
0.
84, 0
.85,
0.7
7, 0
.75,
0.7
8 (D
omin
o, 1
996)
.
AA
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 343
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
• SO
Q-C
6th–
8th
grad
ers
[116
] (D
omin
o et
al.,
198
6)
• SO
Q-C
(Dom
ino
et a
l., 1
986)
1.
Not
men
tione
d.
2. C
onte
nt a
naly
sis
by
prof
essi
onal
s.
3. N
ine-
clus
ter m
odel
. 4.
Not
men
tione
d.
Est
imat
es o
f tes
t-re
test
re
liabi
lity
of fi
ve-f
acto
r m
odel
: 0.9
2, 0
.78,
0.5
5,
0.77
, 0.3
4, 0
.51
(Rog
ers
&
DeS
hon,
199
5).
3. F
aile
d to
con
firm
eig
ht-
fact
or c
linic
al s
cale
mod
el
(Rog
ers
& D
eSho
n, 1
992)
.M
oder
atel
y su
ppor
ted
five-
fact
or m
odel
(Rog
ers
& D
eSho
n, 1
995)
.T
he fi
ve-f
acto
r mod
el
neith
er re
ceiv
ed
uniq
ue p
sych
omet
ric
cont
ribu
tions
nor
sho
wed
su
peri
or c
hara
cter
istic
s co
mpa
red
to e
ight
-fac
tor
clin
ical
sca
le m
odel
(D
omin
o et
al.,
200
0).
Faile
d to
sup
port
15-
fact
or
mod
el, e
ight
-fac
tor m
odel
an
d fiv
e-fa
ctor
mod
el
(And
erso
n et
al.,
200
8).
Faile
d to
sup
port
two-
fact
or m
odel
(And
erso
n
et a
l., 2
008)
.
• SO
Q-C
(Dom
ino
et a
l., 1
986)
1–3.
Not
men
tione
d.
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
344 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
(con
tinue
d)
Tabl
e 1
(con
tinue
d)
Suic
ide
Sem
anti
c D
iffe
rent
ial
Scal
e (S
SDS)
Exa
min
es ju
stifi
catio
n of
sui
cide
(Dro
ogas
et
al.,
1982
–83)
.
Con
sist
s of
10
adje
ctiv
e pa
irs
(e.g
. jus
tified
/no
t jus
tified
, cow
ardl
y/br
ave)
. Res
pond
ents
re
ad fi
ctio
nal s
tori
es
and
answ
er fr
om o
ne
extr
eme
to th
e ot
her o
f ea
ch a
djec
tive
on a
six
-po
int s
cale
(Dro
ogas
et
al.,
1982
–83)
.Fi
ctio
nal s
tori
es w
ere
mod
ified
from
them
es
of th
e st
udie
s (H
iggi
ns
& R
ange
, 199
6, 1
999;
R
ange
& M
artin
, 199
0;
Wer
th &
Lid
dle,
199
4).
The
fict
iona
l sto
ries
w
ere
deve
lope
d on
th
e ba
sis
of e
xten
sive
lit
erat
ure
revi
ew
(Dro
ogas
et a
l.,
1982
–83)
.
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s [8
0] (D
roog
as e
t al.,
19
82–8
3)
Oth
er s
tudi
es: C
olle
ge
stud
ents
[180
] (R
ange
&
Mar
tin, 1
990)
; [30
6]
(Hig
gins
& R
ange
, 19
96);
[192
] (M
ario
n &
R
ange
, 200
3)Ps
ycho
ther
apis
ts [1
86]
(Wer
th &
Lid
dle,
199
4)
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pu
blis
hed.
1. 0
.94
(Wer
th &
Lid
dle,
19
94),
= 0
.85
(Hig
gins
&
Ran
ge, 1
996)
and
0.9
5 (M
ario
n &
Ran
ge, 2
003)
.2.
Not
men
tione
d.
CB
Suic
ide
Inte
rven
tion
Q
uest
ionn
aire
(S
IQ)
Mea
sure
s at
titud
es
tow
ard
inte
rven
ing
with
su
icid
al in
divi
dual
s (U
npub
lishe
d pa
per b
y Ti
erne
y (1
988)
cite
d in
C
hagn
on e
t al.
2007
).
Con
sist
s of
20
item
s ra
ted
on fi
ve-p
oint
L
iker
t sca
le fr
om
‘agr
ee c
ompl
etel
y’ to
‘d
isag
ree
com
plet
ely’
(U
npub
lishe
d pa
per b
y Ti
erne
y (1
988)
cite
d in
C
hagn
on e
t al.
2007
).
No
scal
e de
velo
pmen
t st
udy
has
been
pu
blis
hed.
No
scal
e de
velo
pmen
t st
udy
has
been
pu
blis
hed.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pu
blis
hed.
1. N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.2.
Spl
it-ha
lf re
liabi
lity
coef
ficie
nt: r
= 0
.79;
Te
st-r
etes
t rel
iabi
lity
coef
ficie
nt: r
= 0
.82
(Unp
ublis
hed
pape
r by
Tier
ney
(198
8) c
ited
in
Cha
gnon
et a
l., 2
007)
.
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 345
Suic
ide
Sem
anti
c D
iffe
rent
ial
Scal
e (S
SDS)
Exa
min
es ju
stifi
catio
n of
sui
cide
(Dro
ogas
et
al.,
1982
–83)
.
Con
sist
s of
10
adje
ctiv
e pa
irs
(e.g
. jus
tified
/no
t jus
tified
, cow
ardl
y/br
ave)
. Res
pond
ents
re
ad fi
ctio
nal s
tori
es
and
answ
er fr
om o
ne
extr
eme
to th
e ot
her o
f ea
ch a
djec
tive
on a
six
-po
int s
cale
(Dro
ogas
et
al.,
1982
–83)
.Fi
ctio
nal s
tori
es w
ere
mod
ified
from
them
es
of th
e st
udie
s (H
iggi
ns
& R
ange
, 199
6, 1
999;
R
ange
& M
artin
, 199
0;
Wer
th &
Lid
dle,
199
4).
The
fict
iona
l sto
ries
w
ere
deve
lope
d on
th
e ba
sis
of e
xten
sive
lit
erat
ure
revi
ew
(Dro
ogas
et a
l.,
1982
–83)
.
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s [8
0] (D
roog
as e
t al.,
19
82–8
3)
Oth
er s
tudi
es: C
olle
ge
stud
ents
[180
] (R
ange
&
Mar
tin, 1
990)
; [30
6]
(Hig
gins
& R
ange
, 19
96);
[192
] (M
ario
n &
R
ange
, 200
3)Ps
ycho
ther
apis
ts [1
86]
(Wer
th &
Lid
dle,
199
4)
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pu
blis
hed.
1. 0
.94
(Wer
th &
Lid
dle,
19
94),
= 0
.85
(Hig
gins
&
Ran
ge, 1
996)
and
0.9
5 (M
ario
n &
Ran
ge, 2
003)
.2.
Not
men
tione
d.
CB
Suic
ide
Inte
rven
tion
Q
uest
ionn
aire
(S
IQ)
Mea
sure
s at
titud
es
tow
ard
inte
rven
ing
with
su
icid
al in
divi
dual
s (U
npub
lishe
d pa
per b
y Ti
erne
y (1
988)
cite
d in
C
hagn
on e
t al.
2007
).
Con
sist
s of
20
item
s ra
ted
on fi
ve-p
oint
L
iker
t sca
le fr
om
‘agr
ee c
ompl
etel
y’ to
‘d
isag
ree
com
plet
ely’
(U
npub
lishe
d pa
per b
y Ti
erne
y (1
988)
cite
d in
C
hagn
on e
t al.
2007
).
No
scal
e de
velo
pmen
t st
udy
has
been
pu
blis
hed.
No
scal
e de
velo
pmen
t st
udy
has
been
pu
blis
hed.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pu
blis
hed.
1. N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.2.
Spl
it-ha
lf re
liabi
lity
coef
ficie
nt: r
= 0
.79;
Te
st-r
etes
t rel
iabi
lity
coef
ficie
nt: r
= 0
.82
(Unp
ublis
hed
pape
r by
Tier
ney
(198
8) c
ited
in
Cha
gnon
et a
l., 2
007)
.
Suic
ide
Att
itud
e V
igne
tte
Exp
erie
nces
(S
AVE
-A;
SAV
E-L
)
• SA
VE
-A(S
tillio
n et
al.,
198
4)
Mea
sure
s at
titud
es
tow
ard
suic
ide
amon
g ad
oles
cent
s.
• SA
VE
-L(S
tillio
n et
al.,
198
9)
Mea
sure
s at
titud
es
tow
ard
suic
ide
amon
g th
e el
derl
y.
• SA
VE
-A(S
tillio
n et
al.,
198
4)
Con
sist
s of
10
vign
ette
s de
scri
bing
diff
eren
t cr
isis
situ
atio
ns w
hich
co
uld
lead
to s
uici
dal
atte
mpt
s.
• SA
VE
-L(S
tillio
n et
al.,
198
9)
Con
sist
s of
16
vign
ette
s.Te
n us
ed s
ituat
ions
si
mila
r to
thos
e us
ed
in th
e SA
VE
-A a
nd th
e re
st w
ere
cons
ider
ed
appr
opri
ate
only
for t
he
elde
rly.
For b
oth
SAV
E-A
and
SA
VE
-L, r
espo
nden
ts
use
a fiv
e-po
int s
cale
, ra
ngin
g fr
om lo
w to
hi
gh, t
o ra
te th
e ex
tent
to
whi
ch th
ey s
ympa
thiz
e an
d em
path
ize
with
th
e pr
otag
onis
ts in
the
vign
ette
s an
d th
e ex
tent
to
whi
ch th
ey a
gree
with
pr
otag
onis
ts’ s
uici
de
actio
ns.
Vig
nette
s de
scri
bing
cr
isis
situ
atio
ns w
ere
read
by
a pa
nel o
f ju
dges
to c
onfir
m th
eir
clar
ity, r
eada
bilit
y an
d ad
equa
cy o
f sui
cide
m
otiv
atio
ns (S
tillio
n et
al
., 19
84).
• SA
VE
-A(S
tillio
n et
al.,
198
4)Sc
ale
deve
lopm
ent
stud
y: P
ublic
hig
h sc
hool
stu
dent
s [1
98]
• SA
VE
-L(S
tillio
n et
al.,
198
9)Sc
ale
deve
lopm
ent
stud
y: E
lder
ly p
eopl
e liv
ing
in th
e co
mm
unity
[4
0] a
nd c
olle
ge
stud
ents
[40]
• SA
VE
-A (S
tillio
n
et a
l., 1
984)
1.
Not
men
tione
d.
2. R
evie
wed
by
a pa
nel
of ju
dges
. 3.
Thr
ee fa
ctor
s (c
umul
ativ
e pr
opor
tion:
91
%) c
onfir
med
the
exis
tenc
e of
sym
path
y,
empa
thy
and
agre
emen
t fa
ctor
s.
4. C
orre
late
d si
gnifi
cant
ly a
nd in
th
e pr
edic
ted
dire
ctio
n w
ith e
xter
nal c
rite
ria
(sel
f-es
teem
, dea
th
conc
ern,
dep
ress
ion,
su
icid
e pr
onen
ess
and
relig
iosi
ty).
• SA
VE
-L(S
tillio
n et
al.,
198
9)1.
Not
men
tione
d.2.
Not
men
tione
d.3.
Thr
ee fa
ctor
s (c
umul
ativ
e pr
opor
tion:
55
%) c
onfir
med
the
exis
tenc
e of
sym
path
y,
empa
thy
and
agre
emen
t fa
ctor
s.4.
Cor
rela
ted
sign
ifica
ntly
an
d in
the
pred
icte
d di
rect
ion
with
ext
erna
l cr
iteria
(dep
ress
ion
and
relig
iosi
ty).
• SA
VE
-A(S
tillio
n et
al.,
198
4)1.
Not
men
tione
d.2.
Est
imat
es o
f tes
t-re
test
re
liabi
lity:
0.6
5, 0
.59,
0.
52.
• SA
VE
-L(S
tillio
n et
al.,
198
9)1.
=
0.9
6, 0
.95,
0.8
9.2.
Not
men
tione
d.
BC
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
346 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)Sc
ale
nam
esO
bjec
tives
Scal
e ch
arac
teri
stic
sSc
ale
deve
lopm
ent
Stud
y pa
rtic
ipan
ts [n
]V
alid
ity
Rel
iabi
lity
MW
Suic
ide
Att
itud
e Q
uest
ionn
aire
(S
UIA
TT
)
Com
pare
s at
titud
es
tow
ard
suic
ide
amon
g va
riou
s co
untr
ies
(Die
kstr
a &
Ker
khof
, 19
89).
Con
sist
s of
63
item
s w
ith fi
ve-p
oint
Lik
ert
resp
onse
sca
les
(Die
kstr
a &
Ker
khof
, 19
89).
Aff
ectiv
e, c
ogni
tive
and
inst
rum
enta
l co
mpo
nent
s of
atti
tude
w
ere
adop
ted
as th
e co
ncep
t of a
ttitu
de.
Intr
oduc
ed d
iffer
ent
refe
rent
s (r
espo
nden
t hi
m/h
erse
lf, l
oved
on
e an
d so
meo
ne
else
), bo
th a
s su
icid
e ac
tor a
nd a
s re
cipi
ent
of c
onse
quen
ces
of
suic
ide,
for a
theo
retic
al
defin
ition
of a
ttitu
des
tow
ard
suic
ide.
A s
ynta
ctic
sen
tenc
e co
nsis
ted
of th
ree
face
ts:
acto
rs, r
ecip
ient
s an
d at
titud
e co
mpo
nent
s.C
ombi
natio
ns o
f fac
ets
lead
ing
to a
bsur
ditie
s or
taut
olog
ies
wer
e ex
clud
ed.
The
pre
-tes
t usi
ng th
e in
itial
133
item
s w
as
perf
orm
ed; 7
0 ite
ms
wer
e ex
clud
ed b
ased
on
fact
or a
naly
sis
and
com
men
ts m
ade
by p
re-
test
par
ticip
ants
. (D
ieks
tra
& K
erkh
of,
1989
)
Scal
e de
velo
pmen
t st
udy:
Gra
duat
e st
uden
ts [8
5]
(Die
kstr
a &
Ker
khof
, 19
89).
Valid
atio
n st
udy:
Lay
peo
ple
sele
cted
fr
om 1
1 m
ediu
m u
rban
an
d si
x sm
all r
ural
co
mm
uniti
es in
the
east
ern
Net
herl
ands
[7
12] (
Die
kstr
a &
K
erkh
of, 1
989)
.
1. A
dopt
ed th
eore
tical
co
ncep
ts o
n at
titud
e an
d at
titud
e to
war
d su
icid
e.2.
Not
men
tione
d.3.
As
a fir
st s
tep,
the
thre
e-co
mpo
nent
atti
tude
m
odel
was
par
tially
co
nfirm
ed th
roug
h ex
plor
ativ
e fa
ctor
an
alys
is.
Seco
nd, b
y co
mbi
ning
th
ree
refe
rent
leve
ls
with
thre
e at
titud
e co
mpo
nent
s (c
ogni
tive
and
inst
rum
enta
l co
mpo
nent
s w
ere
brok
en
into
sub
divi
sion
s), 1
9 su
bsca
les
wer
e m
anua
lly
cons
truc
ted
(e.g
. af
fect
ive-
self
sub
scal
e).
Prin
cipa
l com
pone
nt
anal
ysis
for t
he 1
9 su
bsca
les
confi
rmed
th
at th
e th
ree
attit
ude
com
pone
nts
wer
e in
depe
nden
t of e
ach
othe
r and
that
atti
tude
s di
ffer
ed d
epen
ding
on
the
refe
rent
s.4.
Not
men
tione
d.(D
ieks
tra
& K
erkh
of,
1989
)
1.
= 0
.79,
0.7
9, 0
.77
(thr
ee re
fere
nt s
ubsc
ales
). =
0.9
0 (S
UIA
TT
). =
0.4
2, 0
.33,
0.3
6, 0
.50,
0.
52, 0
.72,
0.4
5, 0
.39,
0.
36, 0
.82,
0.8
3, 0
.72,
0.
75, 0
.82,
0.8
2
(19
subs
cale
s, e
xclu
ding
on
e-ite
m fa
ctor
s).
2. T
est-
rete
st re
liabi
lity
coef
ficie
nts:
0.8
1, 0
.65,
0.
67 fo
r thr
ee re
fere
nt
subs
cale
s; 0
.82
for
SUIA
TT.
Te
st-r
etes
t rel
iabi
lity
coef
ficie
nts:
0.6
0, 0
.50,
0.
40, 0
.66,
0.6
8, 0
.64,
0.
59, 0
.62,
0.6
3, 0
.66,
0.
61, 0
.68,
0.5
3, 0
.68,
0.
66, 0
.59,
0.7
1, 0
.51,
0.
56 fo
r 19
subs
cale
s.(D
ieks
tra
& K
erkh
of,
1989
)
AA
Att
ribu
tion
of
Cau
ses
to
Suic
ide
Scal
e
Mea
sure
s co
mpo
nent
s of
atti
tude
s to
war
d su
icid
e (L
este
r & B
ean,
19
92).
Con
sist
s of
one
set
of
com
pone
nts
rela
ted
to c
ause
s to
whi
ch
peop
le a
ttrib
ute
suic
ide
– in
trap
sych
ic p
robl
ems,
in
terp
erso
nal c
onfli
cts
or
soci
etal
pre
ssur
es –
and
tw
o se
ts o
f ite
ms
that
m
easu
re a
n in
divi
dual
’s
pers
onal
app
rova
l or
disa
ppro
val o
f sui
cide
, an
d m
easu
re a
ttitu
des
amon
g in
divi
dual
’s p
eers
an
d cu
ltura
l gro
ups
(Les
ter &
Bea
n, 1
992)
.C
ompo
sed
of 1
8 ite
ms
rate
d on
a s
ix-p
oint
L
iker
t sca
le, r
angi
ng
from
‘str
ongl
y ag
ree’
to
‘str
ongl
y di
sagr
ee’
(Loi
bl &
Vora
cek,
200
7;
Vora
cek
et a
l., 2
007;
W
alke
r et a
l., 2
006)
.
Not
men
tione
d.Sc
ale
deve
lopm
ent
stud
y: C
olle
ge s
tude
nts
in th
e U
S [7
2] (L
este
r &
Bea
n, 1
992)
.
No
valid
atio
n st
udy
of
the
orig
inal
Eng
lish
vers
ion
has
been
pu
blis
hed.
No
valid
atio
n st
udy
of th
e or
igin
al E
nglis
h ve
rsio
n ha
s be
en p
ublis
hed.
CC
Mul
ti-
dim
ensi
onal
Su
icid
e A
ttit
ude
Scal
e (M
SAS)
Info
rmat
ion
not
avai
labl
e.In
form
atio
n no
t av
aila
ble.
Inco
rpor
ated
SAV
E-A
, SA
VE
-L a
nd S
ave-
M
(mea
suri
ng a
ttitu
des
tow
ard
mid
-lif
e su
icid
e),
and
adde
d su
bsca
les
(unp
ublis
hed
pape
r by
Mill
er (1
994)
cite
d in
Stil
lion
& S
tillio
n,
1998
–99)
.
Info
rmat
ion
not
avai
labl
e.N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pub
lishe
d.N
/ AN
/ A
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 347
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Suic
ide
Att
itud
e Q
uest
ionn
aire
(S
UIA
TT
)
Com
pare
s at
titud
es
tow
ard
suic
ide
amon
g va
riou
s co
untr
ies
(Die
kstr
a &
Ker
khof
, 19
89).
Con
sist
s of
63
item
s w
ith fi
ve-p
oint
Lik
ert
resp
onse
sca
les
(Die
kstr
a &
Ker
khof
, 19
89).
Aff
ectiv
e, c
ogni
tive
and
inst
rum
enta
l co
mpo
nent
s of
atti
tude
w
ere
adop
ted
as th
e co
ncep
t of a
ttitu
de.
Intr
oduc
ed d
iffer
ent
refe
rent
s (r
espo
nden
t hi
m/h
erse
lf, l
oved
on
e an
d so
meo
ne
else
), bo
th a
s su
icid
e ac
tor a
nd a
s re
cipi
ent
of c
onse
quen
ces
of
suic
ide,
for a
theo
retic
al
defin
ition
of a
ttitu
des
tow
ard
suic
ide.
A s
ynta
ctic
sen
tenc
e co
nsis
ted
of th
ree
face
ts:
acto
rs, r
ecip
ient
s an
d at
titud
e co
mpo
nent
s.C
ombi
natio
ns o
f fac
ets
lead
ing
to a
bsur
ditie
s or
taut
olog
ies
wer
e ex
clud
ed.
The
pre
-tes
t usi
ng th
e in
itial
133
item
s w
as
perf
orm
ed; 7
0 ite
ms
wer
e ex
clud
ed b
ased
on
fact
or a
naly
sis
and
com
men
ts m
ade
by p
re-
test
par
ticip
ants
. (D
ieks
tra
& K
erkh
of,
1989
)
Scal
e de
velo
pmen
t st
udy:
Gra
duat
e st
uden
ts [8
5]
(Die
kstr
a &
Ker
khof
, 19
89).
Valid
atio
n st
udy:
Lay
peo
ple
sele
cted
fr
om 1
1 m
ediu
m u
rban
an
d si
x sm
all r
ural
co
mm
uniti
es in
the
east
ern
Net
herl
ands
[7
12] (
Die
kstr
a &
K
erkh
of, 1
989)
.
1. A
dopt
ed th
eore
tical
co
ncep
ts o
n at
titud
e an
d at
titud
e to
war
d su
icid
e.2.
Not
men
tione
d.3.
As
a fir
st s
tep,
the
thre
e-co
mpo
nent
atti
tude
m
odel
was
par
tially
co
nfirm
ed th
roug
h ex
plor
ativ
e fa
ctor
an
alys
is.
Seco
nd, b
y co
mbi
ning
th
ree
refe
rent
leve
ls
with
thre
e at
titud
e co
mpo
nent
s (c
ogni
tive
and
inst
rum
enta
l co
mpo
nent
s w
ere
brok
en
into
sub
divi
sion
s), 1
9 su
bsca
les
wer
e m
anua
lly
cons
truc
ted
(e.g
. af
fect
ive-
self
sub
scal
e).
Prin
cipa
l com
pone
nt
anal
ysis
for t
he 1
9 su
bsca
les
confi
rmed
th
at th
e th
ree
attit
ude
com
pone
nts
wer
e in
depe
nden
t of e
ach
othe
r and
that
atti
tude
s di
ffer
ed d
epen
ding
on
the
refe
rent
s.4.
Not
men
tione
d.(D
ieks
tra
& K
erkh
of,
1989
)
1.
= 0
.79,
0.7
9, 0
.77
(thr
ee re
fere
nt s
ubsc
ales
). =
0.9
0 (S
UIA
TT
). =
0.4
2, 0
.33,
0.3
6, 0
.50,
0.
52, 0
.72,
0.4
5, 0
.39,
0.
36, 0
.82,
0.8
3, 0
.72,
0.
75, 0
.82,
0.8
2
(19
subs
cale
s, e
xclu
ding
on
e-ite
m fa
ctor
s).
2. T
est-
rete
st re
liabi
lity
coef
ficie
nts:
0.8
1, 0
.65,
0.
67 fo
r thr
ee re
fere
nt
subs
cale
s; 0
.82
for
SUIA
TT.
Te
st-r
etes
t rel
iabi
lity
coef
ficie
nts:
0.6
0, 0
.50,
0.
40, 0
.66,
0.6
8, 0
.64,
0.
59, 0
.62,
0.6
3, 0
.66,
0.
61, 0
.68,
0.5
3, 0
.68,
0.
66, 0
.59,
0.7
1, 0
.51,
0.
56 fo
r 19
subs
cale
s.(D
ieks
tra
& K
erkh
of,
1989
)
AA
Att
ribu
tion
of
Cau
ses
to
Suic
ide
Scal
e
Mea
sure
s co
mpo
nent
s of
atti
tude
s to
war
d su
icid
e (L
este
r & B
ean,
19
92).
Con
sist
s of
one
set
of
com
pone
nts
rela
ted
to c
ause
s to
whi
ch
peop
le a
ttrib
ute
suic
ide
– in
trap
sych
ic p
robl
ems,
in
terp
erso
nal c
onfli
cts
or
soci
etal
pre
ssur
es –
and
tw
o se
ts o
f ite
ms
that
m
easu
re a
n in
divi
dual
’s
pers
onal
app
rova
l or
disa
ppro
val o
f sui
cide
, an
d m
easu
re a
ttitu
des
amon
g in
divi
dual
’s p
eers
an
d cu
ltura
l gro
ups
(Les
ter &
Bea
n, 1
992)
.C
ompo
sed
of 1
8 ite
ms
rate
d on
a s
ix-p
oint
L
iker
t sca
le, r
angi
ng
from
‘str
ongl
y ag
ree’
to
‘str
ongl
y di
sagr
ee’
(Loi
bl &
Vora
cek,
200
7;
Vora
cek
et a
l., 2
007;
W
alke
r et a
l., 2
006)
.
Not
men
tione
d.Sc
ale
deve
lopm
ent
stud
y: C
olle
ge s
tude
nts
in th
e U
S [7
2] (L
este
r &
Bea
n, 1
992)
.
No
valid
atio
n st
udy
of
the
orig
inal
Eng
lish
vers
ion
has
been
pu
blis
hed.
No
valid
atio
n st
udy
of th
e or
igin
al E
nglis
h ve
rsio
n ha
s be
en p
ublis
hed.
CC
Mul
ti-
dim
ensi
onal
Su
icid
e A
ttit
ude
Scal
e (M
SAS)
Info
rmat
ion
not
avai
labl
e.In
form
atio
n no
t av
aila
ble.
Inco
rpor
ated
SAV
E-A
, SA
VE
-L a
nd S
ave-
M
(mea
suri
ng a
ttitu
des
tow
ard
mid
-lif
e su
icid
e),
and
adde
d su
bsca
les
(unp
ublis
hed
pape
r by
Mill
er (1
994)
cite
d in
Stil
lion
& S
tillio
n,
1998
–99)
.
Info
rmat
ion
not
avai
labl
e.N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pub
lishe
d.N
/ AN
/ A
Tabl
e 1
(con
tinue
d)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
(con
tinue
d)
(con
tinue
d)
348 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)Sc
ale
nam
esO
bjec
tives
Scal
e ch
arac
teri
stic
sSc
ale
deve
lopm
ent
Stud
y pa
rtic
ipan
ts [n
]V
alid
ity
Rel
iabi
lity
MW
Self
-Ass
essm
ent
of A
ttit
udes
To
war
ds
Suic
ide
Info
rmat
ion
not
avai
labl
e. T
his
scal
e w
as
deve
lope
d by
the
Cri
sis
Inte
rven
tion
Cen
tre,
M
inne
apol
is, M
inne
sota
(n
o pu
blis
hed
pape
r av
aila
ble
for t
his
scal
e,
but c
ited
in M
okho
viko
v &
Don
ets,
199
6).
Info
rmat
ion
not
avai
labl
e.In
form
atio
n no
t av
aila
ble.
Info
rmat
ion
not
avai
labl
e.N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pub
lishe
d.N
/ AN
/ A
Und
erst
andi
ng
of S
uici
de
Att
empt
Pat
ient
Sc
ale
(USP
)
Mea
sure
s at
titud
es
of n
ursi
ng p
erso
nnel
to
war
d su
icid
al p
atie
nts
(Sam
uels
son
et a
l.,
1997
a, 1
997b
).
Con
sist
s of
11
item
s ra
ted
on a
four
-po
int L
iker
t sca
le
rang
ing
from
‘I a
gree
co
mpl
etel
y’ to
‘I
disa
gree
com
plet
ely’
(S
amue
lsso
n et
al.,
19
97a,
199
7b).
The
initi
al it
em p
ool
was
dev
elop
ed b
ased
on
the
ques
tionn
aire
cr
eate
d by
Sou
kas
and
Lön
nqui
st (1
989)
. Of
16 it
ems
refle
ctin
g em
otio
nal a
ttitu
des,
four
w
ith lo
w c
orre
cted
-ite
m to
tal c
orre
latio
ns
and
one
with
low
va
rian
ce w
ere
excl
uded
(S
amue
lsso
n et
al.,
19
97a)
.
Scal
e de
velo
pmen
t st
udy:
Psy
chia
tric
nur
ses
in S
tock
holm
, Sw
eden
[1
97] (
Sam
uels
son
et
al.,
1997
a).
Valid
atio
n st
udy:
N
urse
s/as
sist
ant n
urse
s [8
16] (
Ais
h et
al.,
20
02).
1. N
ot m
entio
ned.
2.
Bas
ed o
n a
ques
tionn
aire
by
Souk
as
and
Lön
nqui
st (1
989)
.3.
The
dat
a ob
tain
ed b
y A
ish
et a
l. (2
002)
fitte
d th
e on
e-fa
ctor
mod
el fo
r fiv
e ite
ms,
but
not
for
the
USP
sca
le.T
he s
cale
ha
d hi
gh v
alid
ity, b
ut
rela
tivel
y lo
w re
liabi
lity
(Ais
h et
al.,
200
2).
4. H
ad s
igni
fican
t co
rrel
atio
ns w
ith
‘und
erst
andi
ng’ a
nd
‘will
ingn
ess’
of t
he
VAS
scal
es d
evel
oped
by
Sam
uels
son
et a
l. (1
997a
) (i.e
. str
onge
r em
path
etic
atti
tude
on
the
USP
sca
le w
as
asso
ciat
ed w
ith g
reat
er
unde
rsta
ndin
g an
d w
illin
gnes
s to
nur
se
suic
idal
pat
ient
s).
1.
= 0
.74
(Sam
uels
son
et a
l., 1
997a
).2.
Not
men
tione
d.C
C
Suic
ide
Att
itud
e Q
uest
ionn
aire
Exa
min
es S
outh
Afr
ican
hi
gh s
choo
l stu
dent
s’
attit
udes
tow
ard
suic
ide
(Pel
tzer
et a
l., 1
998)
.
Con
sist
s of
35
item
s ra
ted
on a
five
-poi
nt
Lik
ert s
cale
rang
ing
from
‘defi
nite
ly y
es’ t
o ‘d
efini
tely
no’
(Pel
tzer
et
al.,
199
8).
Dev
elop
men
t was
ba
sed
on e
xist
ing
scal
es
(Pel
tzer
et a
l., 1
998)
.
Sout
h A
fric
an ju
nior
hi
gh s
tude
nts
[622
] (P
eltz
er e
t al.,
199
8).
1. N
ot m
entio
ned.
2. B
ased
on
rela
ted
stud
ies
(Pel
tzer
et a
l.,
1998
).3.
Not
men
tione
d.
4. S
igni
fican
t as
soci
atio
ns w
ith h
avin
g a
frie
nd o
r rel
ativ
e w
ho
com
mitt
ed s
uici
de,
para
suic
ide,
dep
ress
ion,
st
ress
eve
nts,
eth
nici
ty
and
attit
udes
tow
ards
su
icid
e (P
eltz
er e
t al.,
19
98).
1.
= 0
.85.
2. S
plit-
half
relia
bilit
y co
effic
ient
: 0.9
4(P
eltz
er e
t al.,
199
8).
BC
Sem
anti
c D
iffe
rent
ial
Scal
e A
ttit
udes
to
war
ds
Suic
idal
B
ehav
iour
(S
ED
AS)
Mea
sure
s at
titud
e to
war
d su
icid
al
beha
viou
r (Je
nner
&
Nie
sing
, 200
0).
Con
sist
s of
15
seve
n-po
int r
atin
g sc
ales
with
pa
irs
of p
olar
wor
ds
or id
eas
rega
rdin
g su
icid
e in
sev
en a
ctor
/si
tuat
ion
sets
: (a)
my
own
suic
ide;
(b) t
hat o
f an
ado
lesc
ent;
(c) t
hat o
f an
81-
year
-old
per
son;
(d
) tha
t of a
34-
year
-ol
d ad
dict
; (e)
that
of a
pe
rson
with
an
incu
rabl
e tu
mou
r; (f
) tha
t of a
su
icid
e re
peat
er; o
r (g)
th
at o
f a p
erso
n ve
ry
dear
to m
e (J
enne
r &
Nie
sing
, 200
0).
The
initi
al 3
6 se
ven-
poin
t rat
ing
scal
es w
ith
oppo
site
adj
ectiv
es a
t ea
ch e
nd w
ere
sele
cted
ba
sed
on m
enta
l hea
lth
prof
essi
onal
s’ o
pini
ons
and
liter
atur
e re
view
.R
espo
nden
ts a
nsw
er th
e sa
me
list o
f 36
scal
es
for s
uici
des
in th
e se
ven
acto
r/si
tuat
ion
sets
.A
fter
exc
ludi
ng it
ems
with
littl
e va
rian
ce
amon
g an
d w
ithin
the
seve
n se
ts, i
tem
s w
ith
skew
ed o
r kur
tosi
s di
stri
butio
ns, a
nd
thos
e w
ith v
ery
sim
ilar
mea
ning
s, 1
5 ite
ms
rem
aine
d fo
r fur
ther
an
alys
is (J
enne
r &
Nie
sing
, 200
0).
Scal
e de
velo
pmen
t and
va
lidat
ion
stud
y (J
enne
r &
Nie
sing
, 200
0):
Hot
line
volu
ntee
rs [1
36]
Psyc
hiat
ric
nurs
es to
ex
amin
e te
st-r
etes
t re
liabi
lity
[41]
1. N
ot m
entio
ned.
2. B
ased
on
opin
ions
of
men
tal h
ealth
pr
ofes
sion
als.
3. S
imul
tane
ous
com
pone
nt a
naly
sis
indi
cate
d tw
o si
mul
tane
ous
inte
rpre
tabl
e co
mpo
nent
s ac
coun
ting
for 4
7.3%
of
the
tota
l var
ianc
e.Pr
inci
pal c
ompo
nent
an
alys
is a
lso
yiel
ded
two
com
pone
nts
acco
untin
g fo
r 48.
5% o
f the
tota
l va
rianc
e.4.
Res
pond
ents
with
hi
stor
y of
sui
cida
l id
eatio
n ev
alua
ted
thei
r ow
n su
icid
e as
less
ne
gativ
e.5.
The
two
com
pone
nts
wer
e si
gnifi
cant
ly
corr
elat
ed h
ighe
r with
th
emse
lves
acr
oss
the
seve
n se
ts th
an w
ith th
e ot
her c
ompo
nent
acr
oss
the
sets
. Thi
s re
sult
supp
orte
d ad
equa
te
cons
truct
val
idity
(J
enne
r & N
iesi
ng,
2000
).
1.
= 0
.84,
0.7
5, 0
.86,
0.
81, 0
.83,
0.7
9, 0
.85
(firs
t com
pone
nt);
= 0
.78,
0.7
3, 0
.80,
0.7
8,
0.83
, 0.7
6, 0
.83
(sec
ond
com
pone
nt).
2. T
est-
rete
st re
liabi
lity:
r
= 0.
63-0
.87
(Jen
ner &
Nie
sing
, 200
0).
AC
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 349
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Self
-Ass
essm
ent
of A
ttit
udes
To
war
ds
Suic
ide
Info
rmat
ion
not
avai
labl
e. T
his
scal
e w
as
deve
lope
d by
the
Cri
sis
Inte
rven
tion
Cen
tre,
M
inne
apol
is, M
inne
sota
(n
o pu
blis
hed
pape
r av
aila
ble
for t
his
scal
e,
but c
ited
in M
okho
viko
v &
Don
ets,
199
6).
Info
rmat
ion
not
avai
labl
e.In
form
atio
n no
t av
aila
ble.
Info
rmat
ion
not
avai
labl
e.N
o va
lidat
ion
stud
y of
the
scal
e ha
s be
en
publ
ishe
d.
No
valid
atio
n st
udy
of th
e sc
ale
has
been
pub
lishe
d.N
/ AN
/ A
Und
erst
andi
ng
of S
uici
de
Att
empt
Pat
ient
Sc
ale
(USP
)
Mea
sure
s at
titud
es
of n
ursi
ng p
erso
nnel
to
war
d su
icid
al p
atie
nts
(Sam
uels
son
et a
l.,
1997
a, 1
997b
).
Con
sist
s of
11
item
s ra
ted
on a
four
-po
int L
iker
t sca
le
rang
ing
from
‘I a
gree
co
mpl
etel
y’ to
‘I
disa
gree
com
plet
ely’
(S
amue
lsso
n et
al.,
19
97a,
199
7b).
The
initi
al it
em p
ool
was
dev
elop
ed b
ased
on
the
ques
tionn
aire
cr
eate
d by
Sou
kas
and
Lön
nqui
st (1
989)
. Of
16 it
ems
refle
ctin
g em
otio
nal a
ttitu
des,
four
w
ith lo
w c
orre
cted
-ite
m to
tal c
orre
latio
ns
and
one
with
low
va
rian
ce w
ere
excl
uded
(S
amue
lsso
n et
al.,
19
97a)
.
Scal
e de
velo
pmen
t st
udy:
Psy
chia
tric
nur
ses
in S
tock
holm
, Sw
eden
[1
97] (
Sam
uels
son
et
al.,
1997
a).
Valid
atio
n st
udy:
N
urse
s/as
sist
ant n
urse
s [8
16] (
Ais
h et
al.,
20
02).
1. N
ot m
entio
ned.
2.
Bas
ed o
n a
ques
tionn
aire
by
Souk
as
and
Lön
nqui
st (1
989)
.3.
The
dat
a ob
tain
ed b
y A
ish
et a
l. (2
002)
fitte
d th
e on
e-fa
ctor
mod
el fo
r fiv
e ite
ms,
but
not
for
the
USP
sca
le.T
he s
cale
ha
d hi
gh v
alid
ity, b
ut
rela
tivel
y lo
w re
liabi
lity
(Ais
h et
al.,
200
2).
4. H
ad s
igni
fican
t co
rrel
atio
ns w
ith
‘und
erst
andi
ng’ a
nd
‘will
ingn
ess’
of t
he
VAS
scal
es d
evel
oped
by
Sam
uels
son
et a
l. (1
997a
) (i.e
. str
onge
r em
path
etic
atti
tude
on
the
USP
sca
le w
as
asso
ciat
ed w
ith g
reat
er
unde
rsta
ndin
g an
d w
illin
gnes
s to
nur
se
suic
idal
pat
ient
s).
1.
= 0
.74
(Sam
uels
son
et a
l., 1
997a
).2.
Not
men
tione
d.C
C
Suic
ide
Att
itud
e Q
uest
ionn
aire
Exa
min
es S
outh
Afr
ican
hi
gh s
choo
l stu
dent
s’
attit
udes
tow
ard
suic
ide
(Pel
tzer
et a
l., 1
998)
.
Con
sist
s of
35
item
s ra
ted
on a
five
-poi
nt
Lik
ert s
cale
rang
ing
from
‘defi
nite
ly y
es’ t
o ‘d
efini
tely
no’
(Pel
tzer
et
al.,
199
8).
Dev
elop
men
t was
ba
sed
on e
xist
ing
scal
es
(Pel
tzer
et a
l., 1
998)
.
Sout
h A
fric
an ju
nior
hi
gh s
tude
nts
[622
] (P
eltz
er e
t al.,
199
8).
1. N
ot m
entio
ned.
2. B
ased
on
rela
ted
stud
ies
(Pel
tzer
et a
l.,
1998
).3.
Not
men
tione
d.
4. S
igni
fican
t as
soci
atio
ns w
ith h
avin
g a
frie
nd o
r rel
ativ
e w
ho
com
mitt
ed s
uici
de,
para
suic
ide,
dep
ress
ion,
st
ress
eve
nts,
eth
nici
ty
and
attit
udes
tow
ards
su
icid
e (P
eltz
er e
t al.,
19
98).
1.
= 0
.85.
2. S
plit-
half
relia
bilit
y co
effic
ient
: 0.9
4(P
eltz
er e
t al.,
199
8).
BC
Sem
anti
c D
iffe
rent
ial
Scal
e A
ttit
udes
to
war
ds
Suic
idal
B
ehav
iour
(S
ED
AS)
Mea
sure
s at
titud
e to
war
d su
icid
al
beha
viou
r (Je
nner
&
Nie
sing
, 200
0).
Con
sist
s of
15
seve
n-po
int r
atin
g sc
ales
with
pa
irs
of p
olar
wor
ds
or id
eas
rega
rdin
g su
icid
e in
sev
en a
ctor
/si
tuat
ion
sets
: (a)
my
own
suic
ide;
(b) t
hat o
f an
ado
lesc
ent;
(c) t
hat o
f an
81-
year
-old
per
son;
(d
) tha
t of a
34-
year
-ol
d ad
dict
; (e)
that
of a
pe
rson
with
an
incu
rabl
e tu
mou
r; (f
) tha
t of a
su
icid
e re
peat
er; o
r (g)
th
at o
f a p
erso
n ve
ry
dear
to m
e (J
enne
r &
Nie
sing
, 200
0).
The
initi
al 3
6 se
ven-
poin
t rat
ing
scal
es w
ith
oppo
site
adj
ectiv
es a
t ea
ch e
nd w
ere
sele
cted
ba
sed
on m
enta
l hea
lth
prof
essi
onal
s’ o
pini
ons
and
liter
atur
e re
view
.R
espo
nden
ts a
nsw
er th
e sa
me
list o
f 36
scal
es
for s
uici
des
in th
e se
ven
acto
r/si
tuat
ion
sets
.A
fter
exc
ludi
ng it
ems
with
littl
e va
rian
ce
amon
g an
d w
ithin
the
seve
n se
ts, i
tem
s w
ith
skew
ed o
r kur
tosi
s di
stri
butio
ns, a
nd
thos
e w
ith v
ery
sim
ilar
mea
ning
s, 1
5 ite
ms
rem
aine
d fo
r fur
ther
an
alys
is (J
enne
r &
Nie
sing
, 200
0).
Scal
e de
velo
pmen
t and
va
lidat
ion
stud
y (J
enne
r &
Nie
sing
, 200
0):
Hot
line
volu
ntee
rs [1
36]
Psyc
hiat
ric
nurs
es to
ex
amin
e te
st-r
etes
t re
liabi
lity
[41]
1. N
ot m
entio
ned.
2. B
ased
on
opin
ions
of
men
tal h
ealth
pr
ofes
sion
als.
3. S
imul
tane
ous
com
pone
nt a
naly
sis
indi
cate
d tw
o si
mul
tane
ous
inte
rpre
tabl
e co
mpo
nent
s ac
coun
ting
for 4
7.3%
of
the
tota
l var
ianc
e.Pr
inci
pal c
ompo
nent
an
alys
is a
lso
yiel
ded
two
com
pone
nts
acco
untin
g fo
r 48.
5% o
f the
tota
l va
rianc
e.4.
Res
pond
ents
with
hi
stor
y of
sui
cida
l id
eatio
n ev
alua
ted
thei
r ow
n su
icid
e as
less
ne
gativ
e.5.
The
two
com
pone
nts
wer
e si
gnifi
cant
ly
corr
elat
ed h
ighe
r with
th
emse
lves
acr
oss
the
seve
n se
ts th
an w
ith th
e ot
her c
ompo
nent
acr
oss
the
sets
. Thi
s re
sult
supp
orte
d ad
equa
te
cons
truct
val
idity
(J
enne
r & N
iesi
ng,
2000
).
1.
= 0
.84,
0.7
5, 0
.86,
0.
81, 0
.83,
0.7
9, 0
.85
(firs
t com
pone
nt);
= 0
.78,
0.7
3, 0
.80,
0.7
8,
0.83
, 0.7
6, 0
.83
(sec
ond
com
pone
nt).
2. T
est-
rete
st re
liabi
lity:
r
= 0.
63-0
.87
(Jen
ner &
Nie
sing
, 200
0).
AC
(con
tinue
d)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
350 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Att
itud
es
Tow
ard
Suic
ide
Pre
vent
ion
(ASP
)
Mea
sure
s at
titud
es
tow
ard
suic
ide
prev
entio
n (H
erro
n et
al
., 20
01).
Con
sist
s of
14
item
s ra
ted
on a
five
-poi
nt
Lik
ert s
cale
from
‘s
tron
gly
agre
e’ to
‘s
tron
gly
disa
gree
’ (H
erro
n et
al.,
200
1).
A s
erie
s of
inte
rvie
ws
wer
e co
nduc
ted
with
36
hea
lth p
rofe
ssio
nals
. In
terv
iew
que
stio
ns
wer
e ba
sed
on th
e pr
evio
us li
tera
ture
.In
terv
iew
s pr
oduc
ed 6
0 pr
elim
inar
y at
titud
es.
Fina
lly, 2
8 ite
ms
rem
aine
d an
d w
ere
arra
nged
as
a se
ries
of
sta
tem
ents
. Fac
tor
anal
ysis
was
con
duct
ed
for t
he 2
8 ite
ms.
Thi
rtee
n ite
ms
with
<0
.5 lo
adin
gs a
nd
one
that
led
to lo
wer
in
tern
al re
liabi
lity
wer
e el
imin
ated
(Her
ron
et a
l., 2
001)
.
Scal
e de
velo
pmen
t st
udy:
Psy
chia
tris
ts in
tr
aini
ng [8
0] (H
erro
n
et a
l., 2
001)
.
Mai
n st
udy:
Fro
nt-l
ine
heal
th p
rofe
ssio
nals
[1
68] (
Her
ron
et a
l.,
2001
).
1. N
ot m
entio
ned.
2. In
terv
iew
s w
ith h
ealth
pr
ofes
sion
als
(Her
ron
et
al.,
2001
).3.
Not
men
tione
d.4.
Not
men
tione
d.
Scal
e de
velo
pmen
t stu
dy:
1.
= 0
.77.
2. r
= 0
.85.
(Her
ron
et a
l., 2
001)
Mai
n st
udy:
1. N
ot m
entio
ned.
2. N
ot m
entio
ned.
CC
Suic
ide
Att
itud
e an
d A
ttri
buti
on
Scal
e (S
AA
S)
Exa
min
es th
e ef
fect
s of
var
iabl
es in
clud
ing
suic
idal
per
son’
s so
cioe
cono
mic
sta
tus,
ge
nder
and
mar
ital
stat
us o
n at
titud
es
tow
ards
sui
cida
l be
havi
our (
Sorj
onen
, 20
02b)
.
Con
sist
s of
fict
iona
l ca
se s
tori
es fo
llow
ed
by 4
9 se
ven-
poin
t ra
ting
item
s. (S
orjo
nen,
20
02a,
200
2b).
In th
e st
udy,
eac
h re
spon
dent
ra
ndom
ly re
ceiv
ed
one
of th
e ca
se s
tori
es
(Sor
jone
n, 2
002a
, 200
2b,
2004
). C
ompl
etio
n of
a
ques
tionn
aire
took
abo
ut
10 m
inut
es (S
orjo
nen,
20
04).F
ictio
nal c
ases
w
ere
mod
ified
dep
endi
ng
on th
e hy
poth
eses
of
the
stud
ies
(Sor
jone
n,
2002
b; S
orjo
nen,
200
4).
Som
e of
the
orig
inal
ite
ms
wer
e m
odifi
ed
(Sor
jone
n, 2
002a
, 200
4)
or e
limin
ated
(Sor
jone
n,
2004
).
Not
men
tione
d.C
olle
ge s
tude
nts
in S
wed
en [2
93]
(Sor
jone
n, 2
002b
)C
olle
ge s
tude
nts
in S
wed
en [1
98]
(Sor
jone
n, 2
002a
)C
olle
ge s
tude
nts
in S
wed
en [3
25]
(Sor
jone
n, 2
004)
1. N
ot m
entio
ned.
2. N
ot m
entio
ned.
3. S
ix in
terp
reta
ble
fact
ors
cum
ulat
ivel
y ac
coun
ting
for 3
8%
of th
e to
tal v
aria
nce
(Sor
jone
n, 2
002b
).Se
ven
inte
rpre
tabl
e fa
ctor
s cu
mul
ativ
ely
acco
untin
g fo
r 42%
of
the
tota
l var
ianc
e (S
orjo
nen,
200
2a).
4. N
ot m
entio
ned.
1.
= 0
.83,
0.7
4,
0.54
, 0.5
2, 0
.69,
0.5
3 (S
orjo
nen,
200
2b);
= 0
.81,
0.6
8, 0
.64,
0.
66, 0
.65,
0.5
5, 0
.77
(Sor
jone
n, 2
002a
); =
0.7
7, 0
.72,
0.7
4, 0
.69,
0.
60, 0
.66
(Sor
jone
n,
2004
).2.
Not
men
tione
d.
BC
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 351
Tabl
e 1
(con
tinue
d)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Att
itud
es
Tow
ard
Suic
ide
(AT
TS)
Mea
sure
s at
titud
es
tow
ard
suic
ide
in th
e ge
nera
l pop
ulat
ion
(Ren
berg
& J
acob
sson
, 20
03).
• V
ersi
on 1
Con
sist
s of
20
item
s ra
ted
on a
five
-poi
nt
Lik
ert s
cale
from
‘agr
ee
com
plet
ely’
to ‘a
gree
no
t at a
ll’.
• V
ersi
on 2
C
onsi
sts
of 3
4 ite
ms
rate
d on
a fi
ve-p
oint
L
iker
t sca
le fr
om
‘str
ongl
y ag
ree’
to
‘str
ongl
y di
sagr
ee’.
(Ren
berg
& J
acob
sson
, 20
03)
• V
ersi
on 1
Dev
elop
ed u
nder
the
influ
ence
of S
OQ
.T
he 8
0 in
itial
item
s w
ere
sele
cted
bas
ed
on th
e op
inio
ns o
f pr
ofes
sion
als
and
lay
peop
le.
Aft
er e
xclu
ding
item
s w
ith lo
w d
iscr
imin
ativ
e po
wer
or s
hort
com
ings
in
form
ulat
ion,
62
item
s re
mai
ned.
The
62
item
s co
vere
d af
fect
ive,
cog
nitiv
e an
d in
stru
men
tal
com
pone
nts.
• V
ersi
on 2
Dev
elop
ed u
nder
the
influ
ence
of S
UIA
TT
an
d ot
her s
tudi
es.
The
ori
gina
l 20
item
s w
ere
expa
nded
to 6
9 ite
ms.
Aft
er e
xclu
sion
of
impo
rtan
t ref
eren
t lev
els
com
pare
d w
ith th
e D
ieks
tra
and
Ker
khof
’s
stud
y re
sults
, 40
item
s re
mai
ned.
(Ren
berg
&
Jaco
bsso
n, 2
003)
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s in
Sw
eden
[50]
Valid
atio
n st
udie
s:•
Ver
sion
1L
ay p
eopl
e ra
ndom
ly
sele
cted
from
a n
orth
ern
coun
ty o
f Sw
eden
[522
].
• V
ersi
on 2
Lay
peo
ple
rand
omly
se
lect
ed fr
om a
nor
ther
n co
unty
of S
wed
en [6
40]
(Ren
berg
& J
acob
sson
, 20
03)
1. A
dopt
ed th
eore
tical
co
ncep
ts o
n at
titud
e an
d at
titud
e to
war
d su
icid
e.2.
Bas
ed o
n th
e SO
Q,
SUIA
TT,
rela
ted
stud
ies,
and
opi
nion
s of
pr
ofes
sion
als
and
lay
peop
le.
• Ver
sion
1It
was
impo
ssib
le to
ob
tain
an
inte
rpre
tabl
e fa
ctor
mod
el fo
r th
e 62
item
s. A
fter
ex
clud
ing
item
s w
ith
skew
ed o
r hig
h ku
rtos
is
dist
ribu
tions
and
w
ith lo
w in
ter-
item
co
rrel
atio
ns, a
nd th
ose
conc
erni
ng c
ause
s of
su
icid
e, th
e re
mai
ning
22
item
s w
ere
used
fo
r exp
lora
tive
fact
or
anal
ysis
.E
ight
fact
ors
acco
unte
d fo
r 63%
of t
he to
tal
vari
ance
. Ite
ms
wer
e ch
osen
, em
ploy
ing
a 0.
40 lo
adin
g cr
iteri
on, i
n th
e in
terp
reta
tion
of th
e fa
ctor
s.
• Ver
sion
23.
Exp
lora
tory
fact
or
anal
ysis
yie
lded
10
fact
ors
(34
item
s)
cum
ulat
ivel
y ac
coun
ting
for 6
0% o
f the
tota
l va
rian
ce.
Ver
sion
11.
=
0.6
6, 0
.60,
0.4
0,
0.65
, 0.3
4, 0
.53,
0.4
5,
0.38
, 0.5
1.2.
Not
men
tione
d. V
ersi
on 2
1.
= 0
.86,
0.7
2, 0
.64,
0.
63, 0
.45,
0.5
1, 0
.51,
0.
45, 0
.38,
0.5
4, 0
.60.
2. N
ot m
entio
ned.
3.T
he e
ight
-fac
tor m
odel
of
Ver
sion
1 fi
tted
data
fr
om th
e 20
item
s fr
om
the
Ver
sion
2 s
tudy
. (R
enbe
rg &
Jac
obss
on,
2003
)
AA
4. H
ad s
igni
fican
t as
soci
atio
ns w
ith
resp
onde
nts’
sui
cida
l be
havi
ours
.(R
enbe
rg &
Jac
obss
on,
2003
)Tr
init
y In
vent
ory
of
Pre
curs
ors
to
Suic
ide
(TIP
S)
Mea
sure
s ad
oles
cent
s’
attit
udes
tow
ard
situ
atio
nal p
recu
rsor
s to
sui
cide
(Sm
yth
&
Mac
Lac
hlan
, 200
4).
Con
sist
s of
12
item
s (s
ituat
ions
or e
vent
s)
rate
d on
a fi
ve-p
oint
L
iker
t sca
le ra
ngin
g fr
om ‘v
ery
good
reas
on’
to ‘v
ery
poor
reas
on’
for i
ndiv
idua
ls w
ho ta
ke
thei
r ow
n lif
e (S
myt
h &
M
acL
achl
an, 2
004)
.
The
pre
limin
ary
vers
ion
with
25
item
s w
as
deve
lope
d ba
sed
on
an e
xten
sive
lite
ratu
re
revi
ew o
f stu
dies
on
suic
ide
risk
fact
ors
and
even
ts; i
t was
use
d fo
r th
e pi
lot s
tudy
.E
xplo
rato
ry fa
ctor
an
alys
is w
as p
erfo
rmed
an
d ite
ms
with
<0
.5 lo
adin
gs w
ere
elim
inat
ed.
Item
-ana
lysi
s an
d te
sts
of k
urto
sis
and
skew
ness
w
ere
also
con
duct
ed.
Fina
lly, f
our
inte
rpre
tabl
e fa
ctor
s w
ere
chos
en, w
ith th
ree
item
s ea
ch, a
ccou
ntin
g fo
r 69.
75%
of v
aria
nce
(Sm
yth
& M
acL
achl
an,
2004
).
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s,
Dub
lin, I
rela
nd [1
00]
(Sm
yth
& M
acL
achl
an,
2004
).
Valid
atio
n st
udy:
Hig
h sc
hool
stu
dent
s [6
73]
(Sm
yth
& M
acL
achl
an,
2005
).
1. N
ot m
entio
ned.
2. E
xten
sive
lite
ratu
re
revi
ew.
3. E
xplo
rato
ry fa
ctor
an
alys
is y
ield
ed fo
ur
inte
rpre
tabl
e fa
ctor
s ac
coun
ting
for 6
9.75
%
of th
e to
tal v
aria
nce
(12
item
s to
tal)
(Sm
yth
&
Mac
Lac
hlan
, 200
4).
4. T
he T
IPS
subs
cale
s w
ere
sign
ifica
ntly
co
rrel
ated
with
‘d
epre
ssio
n’,
‘sui
cida
lity’
and
‘h
opel
essn
ess’
. Gen
der
diff
eren
ces
wer
e ob
serv
ed (S
myt
h &
M
acL
achl
an, 2
005)
.5.
A s
tepw
ise
mul
tiple
re
gres
sion
ana
lysi
s w
as c
ondu
cted
to
exam
ine
the
pred
ictiv
e va
lidity
of t
he T
IPS
for ‘
depr
essi
on’,
‘sui
cida
lity’
and
‘h
opel
essn
ess’
. Gen
der
diff
eren
ces
in th
e re
sults
w
ere
obse
rved
. The
ov
eral
l per
cent
age
of
vari
ance
was
qui
te lo
w
(Sm
yth
& M
acL
achl
an,
2005
).
1.
= 0
.79,
0.7
7,
0.74
, 0.8
1 (S
myt
h &
M
acL
achl
an, 2
004)
. =
0.7
95, 0
.791
, 0.
798,
0.8
76 (S
myt
h &
M
acL
achl
an, 2
005)
.2.
Not
men
tione
d.3.
Con
firm
ator
y an
alys
is
reve
aled
that
the
orig
inal
fa
ctor
str
uctu
re w
as
repl
icat
ed (S
myt
h &
M
acL
achl
an, 2
005)
.
BC
(con
tinue
d)
(con
tinue
d)
352 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Att
itud
es
Tow
ard
Suic
ide
(AT
TS)
Mea
sure
s at
titud
es
tow
ard
suic
ide
in th
e ge
nera
l pop
ulat
ion
(Ren
berg
& J
acob
sson
, 20
03).
• V
ersi
on 1
Con
sist
s of
20
item
s ra
ted
on a
five
-poi
nt
Lik
ert s
cale
from
‘agr
ee
com
plet
ely’
to ‘a
gree
no
t at a
ll’.
• V
ersi
on 2
C
onsi
sts
of 3
4 ite
ms
rate
d on
a fi
ve-p
oint
L
iker
t sca
le fr
om
‘str
ongl
y ag
ree’
to
‘str
ongl
y di
sagr
ee’.
(Ren
berg
& J
acob
sson
, 20
03)
• V
ersi
on 1
Dev
elop
ed u
nder
the
influ
ence
of S
OQ
.T
he 8
0 in
itial
item
s w
ere
sele
cted
bas
ed
on th
e op
inio
ns o
f pr
ofes
sion
als
and
lay
peop
le.
Aft
er e
xclu
ding
item
s w
ith lo
w d
iscr
imin
ativ
e po
wer
or s
hort
com
ings
in
form
ulat
ion,
62
item
s re
mai
ned.
The
62
item
s co
vere
d af
fect
ive,
cog
nitiv
e an
d in
stru
men
tal
com
pone
nts.
• V
ersi
on 2
Dev
elop
ed u
nder
the
influ
ence
of S
UIA
TT
an
d ot
her s
tudi
es.
The
ori
gina
l 20
item
s w
ere
expa
nded
to 6
9 ite
ms.
Aft
er e
xclu
sion
of
impo
rtan
t ref
eren
t lev
els
com
pare
d w
ith th
e D
ieks
tra
and
Ker
khof
’s
stud
y re
sults
, 40
item
s re
mai
ned.
(Ren
berg
&
Jaco
bsso
n, 2
003)
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s in
Sw
eden
[50]
Valid
atio
n st
udie
s:•
Ver
sion
1L
ay p
eopl
e ra
ndom
ly
sele
cted
from
a n
orth
ern
coun
ty o
f Sw
eden
[522
].
• V
ersi
on 2
Lay
peo
ple
rand
omly
se
lect
ed fr
om a
nor
ther
n co
unty
of S
wed
en [6
40]
(Ren
berg
& J
acob
sson
, 20
03)
1. A
dopt
ed th
eore
tical
co
ncep
ts o
n at
titud
e an
d at
titud
e to
war
d su
icid
e.2.
Bas
ed o
n th
e SO
Q,
SUIA
TT,
rela
ted
stud
ies,
and
opi
nion
s of
pr
ofes
sion
als
and
lay
peop
le.
• Ver
sion
1It
was
impo
ssib
le to
ob
tain
an
inte
rpre
tabl
e fa
ctor
mod
el fo
r th
e 62
item
s. A
fter
ex
clud
ing
item
s w
ith
skew
ed o
r hig
h ku
rtos
is
dist
ribu
tions
and
w
ith lo
w in
ter-
item
co
rrel
atio
ns, a
nd th
ose
conc
erni
ng c
ause
s of
su
icid
e, th
e re
mai
ning
22
item
s w
ere
used
fo
r exp
lora
tive
fact
or
anal
ysis
.E
ight
fact
ors
acco
unte
d fo
r 63%
of t
he to
tal
vari
ance
. Ite
ms
wer
e ch
osen
, em
ploy
ing
a 0.
40 lo
adin
g cr
iteri
on, i
n th
e in
terp
reta
tion
of th
e fa
ctor
s.
• Ver
sion
23.
Exp
lora
tory
fact
or
anal
ysis
yie
lded
10
fact
ors
(34
item
s)
cum
ulat
ivel
y ac
coun
ting
for 6
0% o
f the
tota
l va
rian
ce.
Ver
sion
11.
=
0.6
6, 0
.60,
0.4
0,
0.65
, 0.3
4, 0
.53,
0.4
5,
0.38
, 0.5
1.2.
Not
men
tione
d. V
ersi
on 2
1.
= 0
.86,
0.7
2, 0
.64,
0.
63, 0
.45,
0.5
1, 0
.51,
0.
45, 0
.38,
0.5
4, 0
.60.
2. N
ot m
entio
ned.
3.T
he e
ight
-fac
tor m
odel
of
Ver
sion
1 fi
tted
data
fr
om th
e 20
item
s fr
om
the
Ver
sion
2 s
tudy
. (R
enbe
rg &
Jac
obss
on,
2003
)
AA
4. H
ad s
igni
fican
t as
soci
atio
ns w
ith
resp
onde
nts’
sui
cida
l be
havi
ours
.(R
enbe
rg &
Jac
obss
on,
2003
)Tr
init
y In
vent
ory
of
Pre
curs
ors
to
Suic
ide
(TIP
S)
Mea
sure
s ad
oles
cent
s’
attit
udes
tow
ard
situ
atio
nal p
recu
rsor
s to
sui
cide
(Sm
yth
&
Mac
Lac
hlan
, 200
4).
Con
sist
s of
12
item
s (s
ituat
ions
or e
vent
s)
rate
d on
a fi
ve-p
oint
L
iker
t sca
le ra
ngin
g fr
om ‘v
ery
good
reas
on’
to ‘v
ery
poor
reas
on’
for i
ndiv
idua
ls w
ho ta
ke
thei
r ow
n lif
e (S
myt
h &
M
acL
achl
an, 2
004)
.
The
pre
limin
ary
vers
ion
with
25
item
s w
as
deve
lope
d ba
sed
on
an e
xten
sive
lite
ratu
re
revi
ew o
f stu
dies
on
suic
ide
risk
fact
ors
and
even
ts; i
t was
use
d fo
r th
e pi
lot s
tudy
.E
xplo
rato
ry fa
ctor
an
alys
is w
as p
erfo
rmed
an
d ite
ms
with
<0
.5 lo
adin
gs w
ere
elim
inat
ed.
Item
-ana
lysi
s an
d te
sts
of k
urto
sis
and
skew
ness
w
ere
also
con
duct
ed.
Fina
lly, f
our
inte
rpre
tabl
e fa
ctor
s w
ere
chos
en, w
ith th
ree
item
s ea
ch, a
ccou
ntin
g fo
r 69.
75%
of v
aria
nce
(Sm
yth
& M
acL
achl
an,
2004
).
Scal
e de
velo
pmen
t st
udy:
Col
lege
stu
dent
s,
Dub
lin, I
rela
nd [1
00]
(Sm
yth
& M
acL
achl
an,
2004
).
Valid
atio
n st
udy:
Hig
h sc
hool
stu
dent
s [6
73]
(Sm
yth
& M
acL
achl
an,
2005
).
1. N
ot m
entio
ned.
2. E
xten
sive
lite
ratu
re
revi
ew.
3. E
xplo
rato
ry fa
ctor
an
alys
is y
ield
ed fo
ur
inte
rpre
tabl
e fa
ctor
s ac
coun
ting
for 6
9.75
%
of th
e to
tal v
aria
nce
(12
item
s to
tal)
(Sm
yth
&
Mac
Lac
hlan
, 200
4).
4. T
he T
IPS
subs
cale
s w
ere
sign
ifica
ntly
co
rrel
ated
with
‘d
epre
ssio
n’,
‘sui
cida
lity’
and
‘h
opel
essn
ess’
. Gen
der
diff
eren
ces
wer
e ob
serv
ed (S
myt
h &
M
acL
achl
an, 2
005)
.5.
A s
tepw
ise
mul
tiple
re
gres
sion
ana
lysi
s w
as c
ondu
cted
to
exam
ine
the
pred
ictiv
e va
lidity
of t
he T
IPS
for ‘
depr
essi
on’,
‘sui
cida
lity’
and
‘h
opel
essn
ess’
. Gen
der
diff
eren
ces
in th
e re
sults
w
ere
obse
rved
. The
ov
eral
l per
cent
age
of
vari
ance
was
qui
te lo
w
(Sm
yth
& M
acL
achl
an,
2005
).
1.
= 0
.79,
0.7
7,
0.74
, 0.8
1 (S
myt
h &
M
acL
achl
an, 2
004)
. =
0.7
95, 0
.791
, 0.
798,
0.8
76 (S
myt
h &
M
acL
achl
an, 2
005)
.2.
Not
men
tione
d.3.
Con
firm
ator
y an
alys
is
reve
aled
that
the
orig
inal
fa
ctor
str
uctu
re w
as
repl
icat
ed (S
myt
h &
M
acL
achl
an, 2
005)
.
BC
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Tabl
e 1
(con
tinue
d)
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 353
Tabl
e 1
(con
tinue
d)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Suic
ide
Beh
avio
ur
Att
itud
e Q
uest
ionn
aire
(S
BA
Q)
Mea
sure
s nu
rses
’ at
titud
es to
war
d su
icid
e (B
oteg
a et
al.,
200
5).
Con
sist
s of
21
item
s ra
ted
on v
isua
l ana
logu
e sc
ales
rang
ing
from
‘s
tron
gly
disa
gree
’ at
one
end
and
‘str
ongl
y ag
ree’
at t
he o
ther
(B
oteg
a et
al.,
200
5).
Ado
pted
cog
nitiv
e,
affe
ctiv
e an
d be
havi
oura
l com
pone
nts
of a
ttitu
de. B
ased
on
a lit
erat
ure
revi
ew
and
focu
s gr
oup
inte
rvie
ws
of 2
5 nu
rsin
g pr
ofes
sion
als;
54
pro
posi
tions
on
suic
idal
beh
avio
ur w
ere
prod
uced
. Of t
hese
25
item
s w
ere
sele
cted
by
spec
ialis
ts a
nd u
sed
for t
he p
re-t
est.
Aft
er
excl
udin
g ite
ms
with
lo
w v
aria
nce
or p
oor
form
ulat
ion,
21
item
s re
mai
ned.
(Bot
ega
et a
l.,
2005
).
Scal
e de
velo
pmen
t st
udy:
Nur
ses
[20]
(B
oteg
a et
al.,
200
5).
Valid
atio
n st
udy:
Nur
ses
[317
] (B
oteg
a et
al
., 20
05).
1. A
dopt
ed th
ree
com
pone
nts
of a
ttitu
de.
2. L
itera
ture
revi
ew,
focu
s gr
oup
inte
rvie
ws
and
expe
rt c
onse
nsus
.3.
Thr
ee in
terp
reta
ble
fact
ors
acco
untin
g fo
r 43%
of t
he to
tal
vari
ance
(16
item
s).
4. N
ot m
entio
ned.
(Bot
ega
et a
l., 2
005)
.
1.
= 0
.7, 0
.6, 0
.5
(Bot
ega
et a
l., 2
005)
.2.
Not
men
tione
d.A
C
Suic
ide
Att
itud
e Su
rvey
E
xam
ines
atti
tude
s to
war
d su
icid
e am
ong
Gha
naia
ns li
ving
in th
e U
S (E
shun
, 200
6).
Con
sist
s of
eig
ht it
ems
rate
d on
a fi
ve-p
oint
L
iker
t sca
le ra
ngin
g fr
om ‘s
tron
gly
disa
gree
’ to
‘str
ongl
y ag
ree’
(E
shun
, 200
6).
Dev
elop
ed fr
om
rese
arch
lite
ratu
re a
nd
exis
ting
ques
tionn
aire
s (E
shun
, 200
6).
Gha
naia
ns li
ving
in th
e U
S [8
1] (E
shun
, 200
6).
Not
men
tione
d.1.
=
0.6
9 (E
shun
, 20
06).
2. N
ot m
entio
ned.
BC
Hon
g K
ong
vers
ion
of
Chi
nese
A
ttit
udes
To
war
d Su
icid
e Q
uest
ionn
aire
(C
ASQ
-HK
)
Mea
sure
s C
hine
se
attit
udes
tow
ard
suic
ide
(Lee
et a
l., 2
007)
.
Part
A: C
onsi
sts
of 7
3 ite
ms
rate
d on
five
-poi
nt
Lik
ert s
cale
s ra
ngin
g fr
om ‘g
reat
ly a
gree
’ to
‘gre
atly
dis
agre
e’.
Part
B: C
onsi
sts
of
12 s
cena
rios
rate
d on
12
five
-poi
nt L
iker
t sc
ales
. Res
pond
ents
ra
te th
eir l
ikel
ihoo
d of
co
nsid
erin
g su
icid
e in
th
e sc
enar
ios.
Part
C: C
onsi
sts
of
13 q
uest
ions
abo
ut
soci
odem
ogra
phic
s an
d pr
esen
ce o
f ser
ious
su
icid
al id
eatio
n,
prev
ious
sui
cide
atte
mpt
an
d ha
ving
kno
wn
som
eone
who
atte
mpt
ed
or c
ompl
eted
sui
cide
(Lee
et a
l., 2
007)
.
The
CA
SQ (u
npub
lishe
d pa
per b
y Ph
illip
s (2
004)
cite
d in
Lee
, et
al.,
2007
) was
use
d to
de
velo
p th
e C
ASQ
-H
K. T
he C
ASQ
was
de
velo
ped
base
d on
101
fo
cus
grou
p in
terv
iew
s an
d tw
o pi
lot t
ests
in
2,00
0 ra
ndom
ly s
elec
ted
subj
ects
. Nin
e fo
cus
grou
p in
terv
iew
s w
ere
cond
ucte
d am
ong
82
Chi
nese
sub
ject
s fo
r th
e H
K. P
artic
ipan
ts
incl
uded
peo
ple
of
diff
eren
t age
s, s
uici
de
atte
mpt
ers,
hea
lthca
re
prof
essi
onal
s an
d po
licy-
rela
ted
pers
onne
l. T
he p
relim
inar
y ve
rsio
n of
CA
SQ-H
K c
onsi
sted
of
98
item
s an
d w
as
pilo
t-te
sted
with
96
peop
le (L
ee e
t al.,
20
07).
Scal
e de
velo
pmen
t st
udy:
Indi
vidu
als
of v
arie
d so
ciod
emog
raph
ic
back
grou
nds
[96]
(Lee
et
al.,
200
7).
Valid
atio
n st
udy:
A c
onve
nien
ce s
ampl
e of
Chi
nese
peo
ple
born
an
d liv
ing
in H
ong
Kon
g [1
226]
(Lee
et a
l.,
2007
).
1. N
ot m
entio
ned.
2. E
xten
sive
focu
s gr
oup
inte
rvie
ws.
3. P
art A
: nin
e in
terp
reta
ble
fact
ors,
cu
mul
ativ
ely
acco
untin
g fo
r 36.
1% o
f the
tota
l va
rian
ce.
4. N
ot m
entio
ned.
(Lee
et a
l., 2
007)
1. P
art A
: =
0.3
94,
0.73
5, 0
.693
, 0.5
66,
0.62
3, 0
.604
, 0.5
11,
0.33
4, 0
.308
(Lee
et a
l.,
2007
).2.
Not
men
tione
d.
AB
Obj
ectiv
es: O
bjec
tives
for s
cale
dev
elop
men
t. Sc
ale
char
acte
rist
ics:
Item
cha
ract
eris
tics
incl
udin
g th
e nu
mbe
r of i
tem
s an
d re
spon
se m
etho
ds.
Scal
e de
velo
pmen
t: M
etho
ds u
sed
to d
evel
op th
e sc
ale.
Stud
y pa
rtic
ipan
ts [n
]: T
he n
umbe
r of s
tudy
par
ticip
ants
and
thei
r cha
ract
eris
tics.
Val
idit
y: 1
. Ado
ptio
n of
theo
retic
al c
once
pts
of ‘a
ttitu
de’ o
r ‘at
titud
e to
war
ds s
uici
de’;
2. P
erfo
rman
ce o
f ext
ensi
ve li
tera
ture
revi
ews
and
use
of e
xper
t con
sens
us a
nd/o
r fo
cus
grou
p in
terv
iew
s du
ring
the
proc
ess
of s
cale
dev
elop
men
t; 3.
Inte
rpre
tabl
e re
sults
of f
acto
r ana
lysi
s; 4
. Cor
rela
tions
with
ext
erna
l cri
teri
a; 5
. Oth
ers,
if a
ny.
Rel
iabi
lity:
1. I
nter
nal c
onsi
sten
cy (e
.g. C
ronb
ach’
s c
oeffi
cien
t); 2
. Sta
bilit
y (e
.g. r
esul
ts o
f tes
t-re
test
or s
plit-
half
relia
bilit
y te
sts)
; 3. R
epro
duci
bilit
y (e
.g. r
eplic
ate
of
fact
or s
truc
ture
am
ong
diff
eren
t pop
ulat
ions
); 4
. Oth
ers,
if a
ny.
M: M
ultid
imen
sion
ality
: inc
lusi
on o
f com
preh
ensi
ve a
ttitu
dina
l dim
ensi
ons
base
d on
ext
ensi
ve p
ast s
tudi
es o
r the
oret
ical
bac
kgro
unds
of a
ttitu
des
tow
ard
suic
ide,
and
co
mpo
sitio
n of
mul
tiple
fact
ors
(A: m
eetin
g bo
th c
rite
ria;
B: m
eetin
g on
e of
the
crite
ria;
C: m
eetin
g ne
ither
cri
teri
a).
W: A
ppro
pria
tene
ss fo
r a w
ide
rang
e of
pop
ulat
ions
: not
lim
ited
for u
se a
mon
g pa
rtic
ular
age
gro
ups,
peo
ple
with
a s
peci
fic c
ultu
ral b
ackg
roun
d, o
r tho
se w
orki
ng in
ce
rtai
n pr
ofes
sion
al d
isci
plin
es (A
: mee
ting
the
crite
rion
; B: p
artly
mee
ting
the
crite
rion
; C: n
ot m
eetin
g th
e cr
iteri
on).
(con
tinue
d)
354 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(4)
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Suic
ide
Beh
avio
ur
Att
itud
e Q
uest
ionn
aire
(S
BA
Q)
Mea
sure
s nu
rses
’ at
titud
es to
war
d su
icid
e (B
oteg
a et
al.,
200
5).
Con
sist
s of
21
item
s ra
ted
on v
isua
l ana
logu
e sc
ales
rang
ing
from
‘s
tron
gly
disa
gree
’ at
one
end
and
‘str
ongl
y ag
ree’
at t
he o
ther
(B
oteg
a et
al.,
200
5).
Ado
pted
cog
nitiv
e,
affe
ctiv
e an
d be
havi
oura
l com
pone
nts
of a
ttitu
de. B
ased
on
a lit
erat
ure
revi
ew
and
focu
s gr
oup
inte
rvie
ws
of 2
5 nu
rsin
g pr
ofes
sion
als;
54
pro
posi
tions
on
suic
idal
beh
avio
ur w
ere
prod
uced
. Of t
hese
25
item
s w
ere
sele
cted
by
spec
ialis
ts a
nd u
sed
for t
he p
re-t
est.
Aft
er
excl
udin
g ite
ms
with
lo
w v
aria
nce
or p
oor
form
ulat
ion,
21
item
s re
mai
ned.
(Bot
ega
et a
l.,
2005
).
Scal
e de
velo
pmen
t st
udy:
Nur
ses
[20]
(B
oteg
a et
al.,
200
5).
Valid
atio
n st
udy:
Nur
ses
[317
] (B
oteg
a et
al
., 20
05).
1. A
dopt
ed th
ree
com
pone
nts
of a
ttitu
de.
2. L
itera
ture
revi
ew,
focu
s gr
oup
inte
rvie
ws
and
expe
rt c
onse
nsus
.3.
Thr
ee in
terp
reta
ble
fact
ors
acco
untin
g fo
r 43%
of t
he to
tal
vari
ance
(16
item
s).
4. N
ot m
entio
ned.
(Bot
ega
et a
l., 2
005)
.
1.
= 0
.7, 0
.6, 0
.5
(Bot
ega
et a
l., 2
005)
.2.
Not
men
tione
d.A
C
Suic
ide
Att
itud
e Su
rvey
E
xam
ines
atti
tude
s to
war
d su
icid
e am
ong
Gha
naia
ns li
ving
in th
e U
S (E
shun
, 200
6).
Con
sist
s of
eig
ht it
ems
rate
d on
a fi
ve-p
oint
L
iker
t sca
le ra
ngin
g fr
om ‘s
tron
gly
disa
gree
’ to
‘str
ongl
y ag
ree’
(E
shun
, 200
6).
Dev
elop
ed fr
om
rese
arch
lite
ratu
re a
nd
exis
ting
ques
tionn
aire
s (E
shun
, 200
6).
Gha
naia
ns li
ving
in th
e U
S [8
1] (E
shun
, 200
6).
Not
men
tione
d.1.
=
0.6
9 (E
shun
, 20
06).
2. N
ot m
entio
ned.
BC
Hon
g K
ong
vers
ion
of
Chi
nese
A
ttit
udes
To
war
d Su
icid
e Q
uest
ionn
aire
(C
ASQ
-HK
)
Mea
sure
s C
hine
se
attit
udes
tow
ard
suic
ide
(Lee
et a
l., 2
007)
.
Part
A: C
onsi
sts
of 7
3 ite
ms
rate
d on
five
-poi
nt
Lik
ert s
cale
s ra
ngin
g fr
om ‘g
reat
ly a
gree
’ to
‘gre
atly
dis
agre
e’.
Part
B: C
onsi
sts
of
12 s
cena
rios
rate
d on
12
five
-poi
nt L
iker
t sc
ales
. Res
pond
ents
ra
te th
eir l
ikel
ihoo
d of
co
nsid
erin
g su
icid
e in
th
e sc
enar
ios.
Part
C: C
onsi
sts
of
13 q
uest
ions
abo
ut
soci
odem
ogra
phic
s an
d pr
esen
ce o
f ser
ious
su
icid
al id
eatio
n,
prev
ious
sui
cide
atte
mpt
an
d ha
ving
kno
wn
som
eone
who
atte
mpt
ed
or c
ompl
eted
sui
cide
(Lee
et a
l., 2
007)
.
The
CA
SQ (u
npub
lishe
d pa
per b
y Ph
illip
s (2
004)
cite
d in
Lee
, et
al.,
2007
) was
use
d to
de
velo
p th
e C
ASQ
-H
K. T
he C
ASQ
was
de
velo
ped
base
d on
101
fo
cus
grou
p in
terv
iew
s an
d tw
o pi
lot t
ests
in
2,00
0 ra
ndom
ly s
elec
ted
subj
ects
. Nin
e fo
cus
grou
p in
terv
iew
s w
ere
cond
ucte
d am
ong
82
Chi
nese
sub
ject
s fo
r th
e H
K. P
artic
ipan
ts
incl
uded
peo
ple
of
diff
eren
t age
s, s
uici
de
atte
mpt
ers,
hea
lthca
re
prof
essi
onal
s an
d po
licy-
rela
ted
pers
onne
l. T
he p
relim
inar
y ve
rsio
n of
CA
SQ-H
K c
onsi
sted
of
98
item
s an
d w
as
pilo
t-te
sted
with
96
peop
le (L
ee e
t al.,
20
07).
Scal
e de
velo
pmen
t st
udy:
Indi
vidu
als
of v
arie
d so
ciod
emog
raph
ic
back
grou
nds
[96]
(Lee
et
al.,
200
7).
Valid
atio
n st
udy:
A c
onve
nien
ce s
ampl
e of
Chi
nese
peo
ple
born
an
d liv
ing
in H
ong
Kon
g [1
226]
(Lee
et a
l.,
2007
).
1. N
ot m
entio
ned.
2. E
xten
sive
focu
s gr
oup
inte
rvie
ws.
3. P
art A
: nin
e in
terp
reta
ble
fact
ors,
cu
mul
ativ
ely
acco
untin
g fo
r 36.
1% o
f the
tota
l va
rian
ce.
4. N
ot m
entio
ned.
(Lee
et a
l., 2
007)
1. P
art A
: =
0.3
94,
0.73
5, 0
.693
, 0.5
66,
0.62
3, 0
.604
, 0.5
11,
0.33
4, 0
.308
(Lee
et a
l.,
2007
).2.
Not
men
tione
d.
AB
Obj
ectiv
es: O
bjec
tives
for s
cale
dev
elop
men
t. Sc
ale
char
acte
rist
ics:
Item
cha
ract
eris
tics
incl
udin
g th
e nu
mbe
r of i
tem
s an
d re
spon
se m
etho
ds.
Scal
e de
velo
pmen
t: M
etho
ds u
sed
to d
evel
op th
e sc
ale.
Stud
y pa
rtic
ipan
ts [n
]: T
he n
umbe
r of s
tudy
par
ticip
ants
and
thei
r cha
ract
eris
tics.
Val
idit
y: 1
. Ado
ptio
n of
theo
retic
al c
once
pts
of ‘a
ttitu
de’ o
r ‘at
titud
e to
war
ds s
uici
de’;
2. P
erfo
rman
ce o
f ext
ensi
ve li
tera
ture
revi
ews
and
use
of e
xper
t con
sens
us a
nd/o
r fo
cus
grou
p in
terv
iew
s du
ring
the
proc
ess
of s
cale
dev
elop
men
t; 3.
Inte
rpre
tabl
e re
sults
of f
acto
r ana
lysi
s; 4
. Cor
rela
tions
with
ext
erna
l cri
teri
a; 5
. Oth
ers,
if a
ny.
Rel
iabi
lity:
1. I
nter
nal c
onsi
sten
cy (e
.g. C
ronb
ach’
s c
oeffi
cien
t); 2
. Sta
bilit
y (e
.g. r
esul
ts o
f tes
t-re
test
or s
plit-
half
relia
bilit
y te
sts)
; 3. R
epro
duci
bilit
y (e
.g. r
eplic
ate
of
fact
or s
truc
ture
am
ong
diff
eren
t pop
ulat
ions
); 4
. Oth
ers,
if a
ny.
M: M
ultid
imen
sion
ality
: inc
lusi
on o
f com
preh
ensi
ve a
ttitu
dina
l dim
ensi
ons
base
d on
ext
ensi
ve p
ast s
tudi
es o
r the
oret
ical
bac
kgro
unds
of a
ttitu
des
tow
ard
suic
ide,
and
co
mpo
sitio
n of
mul
tiple
fact
ors
(A: m
eetin
g bo
th c
rite
ria;
B: m
eetin
g on
e of
the
crite
ria;
C: m
eetin
g ne
ither
cri
teri
a).
W: A
ppro
pria
tene
ss fo
r a w
ide
rang
e of
pop
ulat
ions
: not
lim
ited
for u
se a
mon
g pa
rtic
ular
age
gro
ups,
peo
ple
with
a s
peci
fic c
ultu
ral b
ackg
roun
d, o
r tho
se w
orki
ng in
ce
rtai
n pr
ofes
sion
al d
isci
plin
es (A
: mee
ting
the
crite
rion
; B: p
artly
mee
ting
the
crite
rion
; C: n
ot m
eetin
g th
e cr
iteri
on).
Scal
e na
mes
Obj
ectiv
esSc
ale
char
acte
rist
ics
Scal
e de
velo
pmen
tSt
udy
part
icip
ants
[n]
Val
idit
yR
elia
bilit
yM
W
Tabl
e 1
(con
tinue
d)
KODAKA ET AL.: A SYSTEMATIC REVIEW OF SCALES THAT MEASURE ATTITUDES 355
Multidimensionality The initial item pool consisted of approximately 3,000 items derived from extensive literature reviews related to suicide (Domino et al., 1980, 1982). Factor analysis and content analysis differentiated the SOQ items into two to 15 subscales (Anderson et al., 2008; Domino et al., 1980, 1982, 1988; Rogers & DeShon, 1992).
Appropriateness for a wide range of populations The SOQ has been widely used for attitudinal studies in various countries (e.g. Domino, 2002; Domino & Groth, 1997; Domino & Leenaars, 1989; Domino & Takahashi, 1991; Domino et al., 2001). It is intended to compare attitudes toward suicide among communities, evaluation of training or education programmes for professionals, and other related research (Domino et al., 1982).
Suicide Attitude Questionnaire
Validity Two types of theoretical concepts were used in the development of the SUIATT (Diekstra & Kerkhof, 1989). One was a three-component model of attitude, consisting of affective, cognitive and instrumental attitudes. The other concept defined the attitude toward suicide by different referent levels: the actors of suicide (respondents themselves, loved ones, or someone else) and recipients of suicidal actions (respondents themselves, loved ones, or someone else).
The preliminary item pool comprised 133 five-point Likert items that combined three components – actors, recipients and attitude – but excluded items leading to inconsistencies or tautologies in con- text (Diekstra & Kerkhof, 1989). A pre-test using these 133 items was administered to 85 graduate students majoring in clinical psychology. Based on factor analysis and comments made by the pre-test participants, 70 items were excluded and some of the remaining items were revised. The final 63-item scale was administered to 712 lay individuals selected from 11 medium-sized cities and six small rural communities in the Netherlands.
The identically formulated items regarding the referents were combined, and sum scores for each set of items were calculated (Diekstra & Kerkhof, 1989). Explorative factor analysis yielded five factors that cumulatively accounted for 55% of the total variance. Two factors consisted of purely cognitive components, two factors had instrumental components and one factor reflected both cognitive and instrumental components. Diekstra and Kerkhof (1989) reported that the three-component attitude model was only partially confirmed through the explorative factor analysis.
Based on combinations of referent and attitude components, 19 subscales of the SUIATT were constructed (Diekstra & Kerkhof, 1989). Results of principal component analysis for the 19 subscales confirmed that the three attitude components were independent from each other and attitudes toward suicide differed depending upon referents.
Reliability Internal consistency and test-retest reliability coefficients for the 19 subscales were ad-equate to prove reliability of the scales (Table 1). Six weeks after the first administration, the scale was re-administered to 256 participants randomly selected from the original group (Diekstra & Kerkhof, 1989). Correlation coefficients for test-retest reliability were 0.81 for the ‘respondent’ referent, 0.65 for the ‘beloved’, 0.67 for ‘someone else’ and 0.82 for the total SUIATT scale.
Feasibility The SUIATT would not be feasible for large survey studies because of the large number of items. Diekstra and Kerkhof (1989), who developed the SUIATT, also reported that a shorter, simpler form of the scale was needed for use in clinical settings.
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Multidimensionality The three-component attitude model and different referent levels were intro-duced when developing the scale items (Diekstra & Kerkhof, 1989). Factor analyses supported the three attitudinal components as well as different referents with regard to attitudes toward suicide.
Appropriateness for a wide range of population The SUIATT was designed to compare attitudes toward suicide among various countries with different suicide rates and for educational studies (Diekstra & Kerkhof, 1989). Lay people were recruited for the scale development study.
Attitudes Toward Suicide
Validity The first version of the ATTS was developed under the influence of the SOQ (Renberg & Jacobsson, 2003). Professionals with broad experience in the field of suicide issues and a group of lay people both examined this version and made suggestions regarding the item pool. Based on their opinions, 80 items were selected and administered as a pre-test to a group of students. Sixty two items remained after excluding those with low discriminative power or shortcomings in formulation. Questionnaires were then mailed to 710 lay people who were randomly selected from a county in north Sweden. Twenty two items remained after items with extremely skewed or high kurtosis dis- tributions or low correlations with other items were removed. An exploratory factor analysis was conducted, which yielded eight interpretable factors, including 20 items that cumulatively accounted for 63% of the total variance.
The second version of the ATTS was developed using related studies in the field of attitudes toward suicide (Renberg & Jacobsson, 2003). This version also adopted the theoretical concept of attitudes toward suicide with regard to different referent levels introduced by Diekstra and Kerkhof (1989), who developed SUIATT, and the original 20 items were expanded to 69 items. After comparison with results from the study by Diekstra and Kerkhof (1989), only necessary combinations of referents were kept and 40 items remained. The second postal surveys were distributed to 1,000 randomly selected lay people. An exploratory factor analysis yielded 10 interpretable factors, including 34 items that cumulatively accounted for 60% of total variance, after excluding items with <0.40 com- munality or loading. The study also revealed significant associations between attitudes and respon-dents’ suicidal behaviours, which partially confirmed criterion validity.
Reliability The coefficients computed for the first eight factors ranged from 0.38 to 0.66, and for the second 10 factors ranged from 0.38 to 0.86 (Renberg & Jacobsson, 2003). The original eight- factor model fitted the data obtained in the second study, using confirmatory factor analysis with the 20 items derived from the original eight factors.
Feasibility Renberg and Jacobsson (2003) aimed to develop a feasible instrument to measure attitudes toward suicide in the general population via large questionnaire surveys. In fact, the ATTS has been used to assess the efficacy of methodologies used by the European Alliance Against Depression (EAAD) (www.eaad.net). The EAAD aims to improve the care of people with depres-sion by introducing community-based intervention programmes in 17 European countries (Hegerl et al., 2009).
Multidimensionality The ATTS was developed using the earlier development studies of multi-dimensional attitudes toward suicide scales, such as the SOQ and SUIATT (Renberg & Jacobsson, 2003). The exploratory factor analyses in the two studies yielded interpretable factors to categorize attitudes toward suicide.
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Appropriateness for a wide range of populations The ATTS was developed as a feasible instru-ment to measure attitudes toward suicide in the general population (Renberg & Jacobsson, 2003). Surveys for scale validation were administered to randomly selected lay individuals.
DISCUSSION
Through a review of publications regarding attitudes toward suicide, 18 scales were selected as instruments for use in the measurement of attitudes toward suicide or related matters. After reviewing validation studies and organizing scale characteristics, three instruments that are used to assess multidimensional attitudes toward suicide in a wide range of populations were identified: the SOQ, SUIATT and ATTS. Their psychometric characteristics were compared to identify a reliable, valid, multidimensional tool feasible for use in a wide range of populations.
Validity refers to adopting the theoretical concepts of ‘attitude’ or ‘attitude toward suicide’ and provides a guarantee that the correct measurements had been made. Validity of the SOQ scale was determined based on an extensive literature review; however, this was not based on a solid the- oretical framework. The lack of consensus on psychometric properties has become a focus of cri-ticism (Diekstra & Kerkhof, 1989). In contrast, two theoretical concepts were used to develop the SUIATT questionnaire (Diekstra & Kerkhof, 1989). It uses the three-component model of attitude and defines attitudes toward suicide with regard to different referent levels. Particular attention was paid to validity in the development of the ATTS, in which the SOQ, the SUIATT and broad pro- fessional knowledge in suicidology were taken into account (Renberg & Jacobsson, 2003). The ATTS revealed significant associations between attitudes and respondents’ suicidal behaviours, which partially confirmed criterion validity.
Internal consistency, stability and reproducibility of the scales were reviewed for reliability in the present study. Results for all three questionnaires demonstrate relatively good reliability, although some factors were associated with very low coefficients or lack of reproducibility. For instance,
coefficients for internal consistency of the ATTS and some of its subscales were low (Renberg & Jacobsson, 2003). Renberg and Jacobsson (2003) speculated that the area of attitudes measured by the ATTS may be too broad, the nature of these attitudes may be too ambiguous, and the ATTS is administered to a heterogeneous group of people. Thus, this survey requires additional studies, including test-retest reliability studies. Furthermore, we believe that attitudes are not completely stable over time. For this reason, computed measures do not provide as reliable a score as one would wish. Nevertheless, the original eight-factor model fitted the data obtained in the second study (Renberg & Jacobsson, 2003). This result supports the relatively high reliability of the ATTS.
Reliability is also linked to the structure of the questionnaires. The present study demonstrated that all commonly used scales that measure attitudes toward suicide were multidimensional. None-theless, consensus has not been achieved regarding the structure of the SOQ; some studies have two (Anderson et al., 2008), while others have up to 15 subscales (Domino et al., 1982). In contrast, the structure of the SUIATT questionnaire was supported by the three-component attitude model (Diekstra & Kerkhof, 1989). Given that its structure is relatively complicated, the SUIATT has been criticized for providing scores that are difficult to interpret (Botega et al., 2005).
The number of items and complexity of rating usually predict the feasibility of the scale. The SOQ is a complex tool consisting of more than 100 items. For this reason, it is a tool that can be used only in complex studies and is not feasible for clinical use. The SUIATT has similar shortcomings;
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it is composed of 63 multi-faceted items. To overcome the limitations of previous scales, the ATTS was designed to be a feasible instrument for use in the measurement of attitudes toward suicide in the general population via large surveys.
In addition, the range of populations for which the scales were designed were considered. The SOQ was optimized to serve as a wide-range tool, but as previously mentioned, its comprehensiveness poses problems in that it becomes a scale with low feasibility. The SUIATT was intended for similar use and for comparative and educational studies in particular. The ATTS is also appropriate for a wide range of populations; it is not limited for use among certain age groups, people with specific cultural backgrounds, or those working in certain professional disciplines.
When a new scale is developed, its construction should target the developer’s specific research purposes. Developers should more actively explore relationships between attitudes and outcome variables, such as suicidal ideation or intervention skills for suicidal cases, as well as examine the scale’s psychometric properties.
One of the limitations of this study is that only publications written in English were reviewed. There may be more valid, reliable and feasible attitudinal scales reported in non-English publications. Moreover, electronic searches were conducted using only two databases, PubMed and PsychInfo. However, the authors believe that the most important psychometric scales would be used or at least mentioned in studies listed in those major databases.
In conclusion, the three multidimensional scales used for a wide range of individuals in the popu- lation, the SOQ, SUIATT and ATTS, were selected from among 18 scales that measure attitudes toward suicide or related matters. Each has its own characteristics and should be used in accordance with research purposes. Of the three scales, the ATTS appears to be the most feasible and valid instrument, although additional reliability studies are needed. For this reason, future studies are recommended to further increase the understanding of these surveys and document insights gained from their usage.
ACKNOWLEDGEMENT
Funding for this study was provided by a Grant-in-Aid for Scientific Research (20730399).
NOTE
Previous versions of this study were presented at the Asia Pacific Regional Conference of International Association for Suicide Prevention in 2008 and the 33rd Conference of Japan Suicide Prevention Association in 2009.
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Manami Kodaka, PhD, Department of Psychogeriatrics, National Institute of Mental Health, National Centre of Neurology and Psychiatry, Tokyo, Japan.Vita Po"tuvan, BSc, University of Primorska, Primorska Institute of Natural Sciences and Technology, Koper, Slovenia.Masatoshi Inagaki, MD, PhD, Centre for Suicide Prevention, National Institute of Mental Health, National Centre of Neurology and Psychiatry, Tokyo, Japan.Mitsuhiko Yamada, MD, PhD, Department of Psychogeriatrics, National Institute of Mental Health, National Centre of Neurology and Psychiatry, Tokyo, Japan.Correspondence to Manami Kodaka, Department of Psychogeriatrics, National Institute of Mental Health, National Centre of Neurology and Psychiatry, 4-1-1 Ogawahigashi-machi, Kodaira, Tokyo 187-8553, Japan.Email: [email protected]
